PROFITABLE 
OFFICE SPECIALTIES 



BY 



A^DALE COVEY, M. D. 



Author of the Secrets of Specialists, the Non Surgical 

Treatment of the Diseases of Women, the 

Face, Its Diseases, Deformities 

and Blemishes, 

Etc. 



The knowledge that a man can use is the only real knowledge: the only 
knowledge that has life and growth in it and converts itself into practical power, 
The rest hangs like dust about the brain, or dries like raindrops off the stones. 

— Froude. 



FIRST EDITION. 



PHYSICIANS SUPPLY COMPANY, 

Publishers, 

110 Pitcher Street, 

Detroit, - Michigan. 






Copyrighted 1912 

BY 

Physician's Supply Co. 



©CIA328417 

3* 



Preface 



In my former publication ''The Secrets of Special- 
ists," I attempted to point out the methods of treat- 
ment by which many of the unethical physicians have 
made fame and fortune. In this publication I have en- 
deavored to make a companion book which will be of 
more practical value by treating many of the minor 
specialties, which have been used with large financial 
returns by the ethical physician. I have christened this 
book under the title of "Profitable Office Specialities," 
not that I am trying to commercialize medicine ; but with 
a view that an office practice may be conducted in such 
a way as will be conducive to a financial success, on 
the part of the physician and 'profitable" to the patient 
by restoring the greatest jewel in life's crown of hap- 
piness — health. 

I fully realize that there are many subjects briefly 
treated, which could have occupied the entire space of 
this publication. I also realize that most busy practi- 
tioners appreciate pointed and terse facts to exhaustive 
theorizing. I have therefore adopted the former policy 
and leave the latter* for the many voluminous text 
books to which every physician has access. 

One of the principal missions of this book is to en- 
courage the general practitioner to properly equip his 
offices with modern therapeutic appliances, that he may 
be better able to "wage war" against disease, and at 
the same time make the practice of medicine a re- 
munerative profession, as it should be compared with 
other vocations in life. 

I might be criticised for too profusely illustrating 
the different subjects under consideration, but this is ? 



4 PREFACE. 

pictorial age, and to me there is nothing so uninter- 
esting as to read page after page of subject matter, 
with only a vague idea of what is being discussed ; 
therefore to follow the tread of modern times "pictures 
save words" is the only humble apology I have to 
offer. It would often take a whole page, to describe 
in detail a certain instrument, appliance or procedure 
whereby an illustration will give all the details at a. 
glance. 

Many of the different instruments and apparatus 
used to illustrate the subject matter in this book, are 
used without the knowledge of their manufacturers. I 
have often given the manufacturers' name, however, to 
save personal correspondence later. 

These illustrations are the latest types of mechan- 
ical construction and thoroughly reliable in every re- 
spect, although perhaps there are many others just as 
good. 

I have also quoted to some extent from physicians 
who specialize in different subjects, in all instances I 
have endeavored to give these physicians credit for 
their valuable assistance. 

If this book will be the means in awakening a new 
interest in the practice of medicine, and encourage the 
physician to adopt these specialties,- he has my assur- 
ance that he will be amply rewarded, both financially 
and professionally. 

It will be a pleasure on my part to assist any phy- 
sician in selecting and installing office equipments, or 
personally advise physicians regarding any of the spe- 
cialties given in the following pages, with a view that 
they may obtain and maintain success, therefore your 
correspondence is solicited. 

625 Third Ave., A. Dale Covey, M. D. 

Detroit, Mich. 



Foreword 



If we would allow our minds to drift back to the 
importance of the insignificant, we would find that 
many of the world's greatest achievements originated 
from apparently little things ; in fact, a man's life is 
made up of an aggregation of little things. From the 
cradle to the grave, life is covered by a series of events, 
each small in itself, but all lengthening into a chain 
which comprises the span of earthly being. Shakes- 
peare has said, "Some men are born great, some achieve 
greatness and some have greatness thrust upon them." 
This is quite true, but the really great men of the 
world, those who have built the imperishable structures 
of success, and pointed out the way to civilization and 
progress, leaving behind them the golden heritage of 
mighty achievements, did not have greatness thrust 
upon them, as the present Czar of Russia, but will more 
often be found among the common people. The writings 
and teachings of the late Count Leo Tolstoi will have 
a greater influence upon the world's future progress 
and civilization than all the wars brought to that nation 
through church and state. 

In achieving greatness from little things we have 
had a Watt, who observed the steam pouring from the 
spout of a kettle, and evolved the steam engine. Davy, 
experimenting in the kitchen with pots and pans, dis- 
covered the safety lamp for miners. Edison says, "I 
was singing to the mouthpiece of a telephone, when 
the vibrations of my voice caused a fine steel point to 
pierce one of my fingers, held just behind it, that set 
me to thinking; if I could record the emotions of the 
point and send it over the same surface afterwards, I 
could see no reason why the thing would not talk." 



6 FOREWORD. 

He made the experiment and the phonograph is the 
result of the pricking of a finger. 

So trifling a matter as the seaweeds floating past 
his ship enabled Columbus to quell mutiny, which rose 
among his sailors at not discovering land, and to assure 
them that the eagerly sought for New world was not 
far off. 

The quacking of a goose is fabled to have saved 
Rome from the invading Gauls, and flies hastened the 
birth of American Independence. The continental con- 
gress held its meeting near a livery stable ; its mem- 
bers wore knee breeches and silk stockings, and with 
handkerchiefs in hand, were diligently employed in 
lashing flies from their legs. To so great an impatience 
did the annoyance arouse the sufferers that it hastened, 
if it did not aid, in inducing them to promptly sign 
their names to that immortal document, the greatest 
ever penned, namely, The Declaration of Independence. 

In all the world we find nothing which exists 
wholly within itself. There seems to be no form of 
existence so low, no atom so small, that it has not 
its appointed task in the economy of nature ; even the 
dust which we despise, and with which the house- 
keeper wages a life long war, has, within a few years, 
been found to render varied and' wonderful service. 
It gives to us the blue of the sky and of the sea; it 
is the canvas on which the sun paints the gorgeous 
colors of the morning and of the evening; without the 
dust there would be no diffused daylight. We would 
have to choose between the glare of the sun's direct 
rays and total darkness. 

In the sciences, we have had a Newton unfolding 
the composition of light and the origin of colors, with 
a prism, a lens, and a piece of cardboard, and demon- 
strating the laws of gravity by the fall of an apple. 
Galileo conceived the idea of the telescope by watching 
little children putting pieces of glass on top of one 
another. Imprisonment could not convince him that 
the earth was stationary. 

What has been discovered from the apparently in- 



FOREWORD. 7 

significant in nature and the sciences is equally true 
with the healing art. Franklin brought electricity from 
the clouds with a paper kite and key, which was fol- 
lowed by Galvani, an Italian anatomist, whose wife 
was making soup from frogs put them in proximity to 
a charged electrical machine; on touching them with a 
scalpel their legs became greatly convulsed. He then 
united the lumbar nerves of a dead frog with its crural 
muscles by a metallic circuit, and came to the conclu- 
sion that animal electricity existed in the nerves and 
muscles of frogs. His experiments, together with those 
conducted by his contemporary, Volta, have developed 
into the present system of Electro-therapeutics. 

Hahnemann, the founder of Homeopathy, after grad- 
uating at the University of Erlangen and practicing the 
old school methods for several years, found that aconite 
and other remedies used at that period were given in 
too large and often in toxic doses, which produced 
more harm than good. Being disgusted with the pre- 
vailing methods of treatment, he abandoned his profes- 
sion and devoted himself to chemical research and the 
physiological action of drugs. In these investigations, 
he occupied six years ; they proved to him that, in all 
instances, the medicine which had cured produced a 
similar condition in healthy persons to that it had 
relieved. This conclusion he published in an essay in 
Hufeland's Journal in 1796. It was in this essay that 
the principle of Similia Similibus Curantur, "similar 
things are cured by ^similar things," was put forward 
by him. His views at once met with vehement opposi- 
tion and are, even to this day, severely ridiculed by 
many members of the old school practitioners. If these 
physicians, however, would take the pains to investi- 
gate the physiological action of drugs they would dis- 
cover that Hahnemann's fundamental principles are 
correct in most instances. 

Referring to Potter's Materia Medica, or any other 
Materia Medica of the old school, we find that in toxic 
doses and in the physiological action of aconite, "the 
heart rate becomes very rapid." Concerning its thera- 



8 FOREWORD. 

peutic action we see stated: "It has well been called 
the therapeutic lancet. Its power over the circulation, 
to control forcible cardiac action renders it of the 
greatest value in all affections characterized by a high 
resisting pulse." Potter further states that "aconite is 
best administered in small doses." Quoting from the 
same author, (Potter), we find that quinine has, "in 
many well authenticated instances apparently caused 
a well marked febrile paroxysm, beginning with a chill, 
then fever and headache which gradually subsided, 
with slight perspiration," resembling in nearly all its 
details intermittent fever. 

Name a remedy which will produce symptoms re- 
sembling syphilis more than mercury, and show me a 
text-book of the old school, in which mercury is not 
pointed out as the specific treatment; "touching the 
gums" with this remedy is the first step sought for 
by nearly all practitioners. We could study the physi- 
ological action of nearly every medicine used by the 
Homeopaths, and find the laws of Similia founded 
upon a logical basis; and, although Hahnemann's teach- 
ing was not directed toward the high potencies it es- 
tablished a basis for the study of the physiological 
action of drugs. 

Dr. Samuel Thompson, the founder of the Botanic 
school of medicine, was laughed at when he was seen 
carrying his little tin teapot from house to house, to 
administer infusions from roots and herbs, which he 
had garnered from nature's vast laboratory of healing 
products ; yet he laid the foundation which has been 
evolved into the Eclectic system of medicine. I have 
always admired the word "eclectic ;" it has a meaning, 
— selecting or choosing from different systems In 
the broad sense of the term, all liberal and broad- 
minded physicians are eclectic. 

Dr. Still, who was a surgeon in the United States 
army during the civil war, observed that the soldiers 
were only human machines, that might become im- 
paired by fatigue or injury, the same as other pieces 
of mechanism. From this reasoning, he conceived the 



FOREWORD. 9 

idea that manipulation could be made to stimulate 
functions to their normal activity, and concluded that 
he had found a new science. To this system of heal- 
ing he gave the name "Osteopathy," not because he 
regarded all healing as "bone setting," but because he 
regarded the bones as nature's medium of manipulating 
the human system; just as the different schools of 
medicine regard drugs as a means of healing disease. 
Through Dr. Still's instructions has been laid the foun- 
dations for vibratory massage, chiropractic, thera- 
peutics, etc. 

In investigating psycho-therapeutics we find the 
same hum'ble beginning: the "shrine of our lady" at 
Lourdes was discovered by two little children, who 
were gathering fire wood in the forest; yet if we could 
witness the pilgrimages to these holy waters and ac- 
cept the authenticated reports of cures we would bow 
our heads in reverence. 

When Mrs. Eddy, the late Lydia Pinkham of the 
soul, and the founder of Christian science, was a hys- 
terical maniac, and would live for days at a time in an 
almost continuous state of collapse, her good husband, 
Mark Baker, would take the grown woman in his arms 
and rock her to sleep like a baby, for which treatment 
she seemed to have a mania ; she little realized that 
self-control of mind would develop into a sacriligious 
healing art (?), which is neither Christianity nor sci- 
ence, yet her teachings are reverenced by over one mil- 
lion disciples. 

I have always attempted to make it a practice, if I 
could not say something good about a person or cause 
to say nothing at all. I will, therefore, refer my read- 
ers to Mrs. Eddy's book "Science and Health," which, 
according to my belief, could be synonymed "pseudo- 
nonsense." 

•We find there are as many "pathies" in the healing 
art as there are creeds and dogmas in religion, and 
while each sectarian college is endeavoring to excel the 
other, as physicians we are all aiming at the same 
physiological target — to maintain and retain health. 



10 FOREWORD. 

When we prove our poor markmanship, and waste our 
ammunition on the desert air our reverend brethren are 
dogmatically directing our pathway towards only one 
great pinnacle — the immortality of our souls. 

There has been much said in medical literature re- 
garding a united medical profession, but little advance- 
ment has been made in this direction. The medical 
profession within the last few years, however, has 
learned that medicine alone does not play the only im- 
portant role in restoring health to the sick and suffer- 
ing, and there are many drugless sanitariums contribut- 
ing their records of success in healing the sick. As dis- 
ciples of Hippocrates, we must accept the truth when it 
is placed before us in an unquestionable manner We 
therefore find electricity, baths, manual and vibratory 
massage, osteopathy, heat, light, rest, and allied thera- 
peutics, as adjuncts to medicine, are indispensable as 
therapeutical measures. To the hard shelled medical 
practitioner, who is wedded to his "pill bags," these 
adjuncts may appear as little things, yet, in reality, they 
are the big things which will assist him in a profes- 
sional and financial way. 

Every physician may not achieve the reputation of 
being a great surgeon, pathologist or therapeutist, yet 
in his humble way, he may be doing more good for 
humanity's sake in healing the sick and alleviating suf- 
fering than some of the greater lights, and to receive 
the gratitude of his patients will not always depend 
upon some capital surgical operation or heroic therapeu- 
tic measure. I have often received more gratitude for 
the eradication of some unsightly scar, birthmark or 
even mole on the face than I have for the removal of a 
large malignant growth elsewhere on the body. 

If the information contained in the following pages 
will render any assistance in directing the pathway to- 
ward success by pointing out the way whereby the 
apparently little things have proven successful in the 
healing art, the writer will feel that this little book has 
quite fulfilled its mission. 



OFFICE EQUIPMENT. 11 



Office 
Equipment 



One of the most important things to be considered 
in adopting the office specialties, is a convenient suite 
of office rooms and their equipment. The work-shop 
of the physician is of as great, or even greater impor- 
tance than the one of other vocations in life, and a 
well located and finely equipped office, not only allows 
the physician to combat with disease to a better ad- 
vantage, but also reacts, in both a professional and 
financial way, by what may be termed silent ethical 
advertising. Physicians do not realize the impression 
it leaves upon their patients' minds to witness all the 
modern, therapeutic appliances and apparatus in opera- 
tion; an impression of prosperity and success, and that 
you are abreast with the times in all modern and sci- 
entific methods of treatment, which is true; this alone, 
will give you a professional standing, which can only be 
duplicated by other physicians who follow in your 
wake. 

In former years many physicians have been accus- 
tomed to a few text ]?ooks, a few surgical instruments, 
and access to drug store supplies of deteriorated tinc- 
tures, extracts and elixirs ; these, together with a medi- 
cine case, filled with the products borrowed from the 
drug store, and an office in their hats, constituted the 
equipment of fully one-half the physicians in the United 
States. Today the progressive physician considers his 
office, livery, and other equipments his professional as- 
sets, and his skilj in utilizing them his liabilities ; and to 
mantain a successful balance depends upon his execu- 
tive qualifications. The old adage that "fine feathers 
make fine birds" is perhaps more true in a physician's 



12 OFFICE EQUIPMENT. 

life than in any other profession A pleasing personal- 
ity and personal magnetism establish a feeling of friend- 
liness between physician and patient; a well-appointed 
office, with a thoroughly scientific equipment, is among 
the most valuable of a physician's assets. Just as the 
personality of some men is attractive, and that of others 
repulsive, so are the personal environments of some 
physicians' offices attractive, while in others they are 
repellant. Although a physician may pride himself 
upon being punctual in attendance at office hours, he is 
frequently detained on some important case, which will 
not allow him to meet his appointments. What is there 
that can be more discouraging to the patient who is in 
ill-health and naturally nervous, and restless than to 
be required to wait in a bare, dismal, cheerless room; 
destitute of pictures, with a few magazines dated several 
years back, and often uncomfortable chairs? A physi- 
cian's business, like all others, should have the modern 
tendency toward comfort and even luxury in its sur- 
roundings, and his reception room should be the first to 
receive careful consideration. Let the walls be decor- 
ated with appropriate pictures, incident to a physician's 
life, and those which appeal to the imagination and the 
sense of beauty ; arrange the bric-a-brac, curios and 
other decorations so they will excite the interest of the 
beholder. Allow your .chairs to be the most comfort- 
able obtainable. An open fireplace is a luxury in any 
room, as the glow of the fire offers cheerfulness, and 
the solace of the grate has a therapeutic influence upon 
many patients. Your reception room table should be 
loaded with the latest periodicals from both the literary 
and cosmopolitan press ; in fact the room, in general, 
should be furnished in as luxurious and attractive ways 
as possible. Such evidence of good taste and refine- 
ment has much to do in reinforcing the personal qual- 
ities and the professional skill of the physician. If you 
have an office attendant, be sure to avoid the pessimis- 
tic, gossiping crank ; select one whose cheerfulness pre- 
dominates, and the corners of her mouth turn upwards, 
always remembering the value of a smile : 



OFFICE EQUIPMENT. 13- 

"The thing that goes the farthest 
Towards making life worth while; 
That costs the least, and does 
The most, is just a pleasant smile. 
The smile that bubbles from the 
Heart that loves its fellowmen, 
Will drive away the clouds of 
Gloom and let the sunshine in. 
'Tis full of worth and. goodness too, 
With genial kindness blent ; 
'Tis worth a million dollars, and 
It doesn't cost a cent. 

The presiding princess of your office should not only 
be a good entertainer, and exercise every effort to re- 
tain patients during your absence, but she should pos- 
sess qualifications sufficient to allow her to assist you 
with your operations, etc. 

Th,e next important room to be considered is your 
consultation apartment; this room should be furnished- 
to conform with the reception room, in taste of arrange- 
ment, etc., and may also be used as a general operat- 
ing and treatment room, as it generally is by most phy- 
sicians who have limited space. In this room may be 
placed the electric machines and appliances, the thera- 
peutic "lamp, electric vibrator, surgical chair, atomizers, 
nebulizers, etc., although many physicians prefer to 
treat the throat, nose and lungs in a separate room, 
owing to the disagreeable odor from the medications. 
They, therefore, use another room, which they call the 
"inhalitorium ;" the walls are either tiled or papered 
with polished bathroom paper, which can be washed 
and kept antiseptic for surgical work. It is also a 
great advantage to have an additional room, equipped 
in the same way. If baths are incorporated in your 
armamentarium, you will require more space ; one or 
two rooms for giving the baths proper, and at least 
two rest rooms, where patients can undress and dress,. 
and also rest after the baths, until their bodies have be- 
come acclimated to the prevailing out-door temperature.. 



14 OFFICE EQUIPMENT. 

The subject of baths will be more thoroughly discussed 
in another chapter. 

In order that the reader may form some conception 
of the arrangement of the offices in question, he is 
referred to the accompanying illustrations. Similar of- 
fices could be arranged in any city where the erection 
of buildings is constantly going on ; you will always 
find the landlord willing to give you a long lease, and 
arrange the rooms to suit your taste. It is a great ad- 
vantage to locate your offices on a corner, owing to the 
light in all the rooms from the side, and not through 
skylight. Many physicians prefer to occupy an entire 
house and conduct a cottage sanitarium. This will also 
be found a profitable enterprise, if the location is such 
that you are assured of a reasonable patronage. The 
cottage sanitarium has a great advantage over the offi- 
ces outlined in the foregoing paragraph, inasmuch as 
you can have your patients constantly under your ob- 
servation. This is very desirable in many cases, espe- 
cially where surgery, the alcohol and drug habit, can- 
cer and other similar diseases are placed under your 
care for treatment. 

In taking under consideration such an enterprise the 
first question a physician will ask is : Will I be suffi- 
ciently remunerated for the extra outlay of money to 
justify me in scientifically arranging such offices? This 
brings us to the point of what equipment we will in- 
stall, and the cost of same. 

Modern inventive genius has made great advance- 
ments within the last few years, and today the physi- 
cian can install scientific appliances, and apparatus at 
almost any price that will fit his purse. This is illus- 
trated in the two cuts, given on another page, of nebul- 
izers ; one is sold for $12.50 complete, while the other 
is valued at $50.00. One machine will do as good work 
as the other; although the cheap machine is not as con- 
venient for the physician, nor as attractive to the pa- 
tient, the therapeutic value is upon an equal basis, and 
such is the case with nearly all other mechanical aids. 
Physicians can also make as large a display with their 



OFFICE EQUIPMENT. 



15 




16 



OFFICE EQUIPMENT. 



apparatus as they desire, or have it condensed in as 
small a space as they wish. This is exemplified by one 
of the latest creations, which is known as the Siebert- 
Welch apparatus, (see cut.) This wonderful little piece 
of condensed mechanism only occupies a space fifteen 
inches square by forty-five inches high, and weighs not 
to exceed one hundred pounds ; yet within its walls are 
contained a complete atomizing and nebulizing outfit, 




SIEBERT-WELCH APPARATUS. 

hot air douch, vacuum apparatus for conducting Bier's 
hyperemic treatment, tankless compressed air, complete 
vibratory massage outfit, superheated air and vacuum 
combined. Galvanic electricity and a combination of 
vibration, dilation, contraction and massage are possible 
of administration at one time, known as the Intro- 
gymnastic treatment. This equipment may not be as 



OFFICE EQUIPMENT 



17 



attractive as the different instruments stretched along 
the walls where they will make a better display, but 
such an apparatus will be exceedingly convenient for 
the physician with small office space. What is true 
with the technical outfitting is also true with toilet 
requisites and other office furniture, as is illustrated in 
the accompanying cuts. 

In selecting scientific equipment for the advanced 
therapeutics will depend largely upon the amount of 
space you expect to occupy, and the amount of capital 




Physician's Supply Co.'s portable lavatory can be installed in any office with- 
out city water supply in five minutes. 



you wish to expend. In order that I may give the 
reader some idea of such an equipment, I will briefly 
outline some of the accessories required, and the min- 
imum and maximum cost of same. 

Minimum Maximum 

Operating chair or table $12.50* to $100.00 

Atomizing and Nebulizing outfit. . 12.50 " 50.00 



13 OFFICE EQUIPMENT. 

Vibratory outfit .... 15.00 " 75.00 

Galvanic and Faradic Electric Cab- 
inet 22.50 " 75.00 

Static 'Machine and accessories 150.00 " 300.00 

Therapeutic Lamp outfit.. 30.00 " 100.00 

Bath equipment 100.00 " 300.00 

Optical Case for fitting glasses " 60.00 

Ozone outfit 30.00 " 200.00 

While the above are the essential requirements for a 
thorough scientific equipment, some may be omitted 
and others added, depending upon the location of ofjfi- 
ces, the demand of the public and the desire of the 
physician. To fulfill these by the above estimates it 
will be seen that a completely furnished office, includ- 
ing all furniture, mechanical apparatus, etc., may be 
secured at prices ranging from five hundred to fifteen 
hundred dollars. I have always deemed it a good pol- 
icy, however, to secure the best, not only because "a 
thing of beauty is a joy forever," but because the better 
grade of apparatus will not become impaired from con- 
stant use, but can always be depended upon when de- 
sired. The next question the physician may consider 
is : will the extra expenditure of capital justify him in 
establishing such an enterprise and where will he lo- 
cate? 

For the last ten years I have been a very close ob- 
server of this method of conducting a medical practice, 
and I have never known of a single instance where a 
physician has made a failure. On the other hand, nearly 
every practitioner has informed me that he has in- 
creased his yearly income over one hundred percent. 
Most physicians conduct their business under their 
own names, while others prefer the name of sanitarium, 
hospital, institute, etc. This is particularly so where a 
residence is occupied for offices ; thus we find the Red 
Cross Sanitarium, Doctor Brown's Medical Institute, 
Doctor Hay's Electro-Medical Institute, Doctor Cov- 
ert's Inhalitarium, Doctor Ball's Gold Cure Institute or 
Retreat, Dr. Clark's Cancer Hospital, and others located 
throughout the country. Where a single specialty is 



OFFICE EQUIPMENT. 



19 



practiced as cancer, or alcohol and the drug habits, it 
is generally in the name, as above, but inasmuch as the 
treatment of these specialties have been robbed of its 
mysteries, have cease'd to 1 be a "trick." Any physician 
can treat these pathological conditions by following the 
instructions given in the following pages, there is no 
reason why they should not be incorporated in every 
physician's practice. 

The erroneous opinion has prevailed among physi- 
cians that such an office or institution should be located 
in a city, but such is not the case, as medical competi- 




The above cut illustrates the Physicians Supply Co.'s Improved Operating 
Table. This table is made of oak, highly polished, and fills all the requirements 
of a physician's operating table or chair. Both ends can be raised or lowered 
independently, at any desired angle. It is provided with an extension, sliding 
out from either side, convenient for holding the arm or instruments during an 
operation. It has two stirrups, which can be adjusted to any length and con- 
cealed when not in use. As an economical (Price $10.00) and desirable piece of 
office furniture it is doubtful if the table can be excelled. 

tion is fairly well equalized throughout the country. I 
have known physicians who have established these offi- 
ces in hamlets of less than five hundred population, 
that have patients visit them from the city, and other 
places hundreds of miles distant. In selecting a new 
location, however, I would advise a physician to choose 
a city which, contains a population from five thousand 
upwards. In the following pages I will outline many 
specialties which may be used to great advantage in 
office practice. These aids I have divided into the 
physiologic methods of treatment, and medical and 
surgical specialties. 



20 PHYSIOTHERAPY 



Physiotherapy 



Under the above caption may be described all the 
physical or so-called "physiologic methods" of treat- 
ment which have entered largely into the therapeutic 
field within the last half and quarter century. In the 
broad sense of the term they incorporate nearly all 
methods of healing other than medicine itself; it is, 
therefore, the drugless method and the natural method 
of treating disease. Many of these methods are the 
oldest known to man ; but only within recent years have 
they been harnessed by science, and recognized and 
utilized by the medical profession as a scientific means 
of treating disease. It was nearly a half century ago 
that Dr. Oliver Wendell Holmes made the classical 
remark, "If all the drugs were cast into the sea it would 
be well for man, but bad for the fishes.'' There is no 
doubt that this veteran in American medicine was far 
seeing in his predictions, and realized that medicine 
alone was a deficient means of treating the sick and 
alleviating suffering in all diseases, and the future phy- 
sicians would utilize accessories and adjunct means to 
restore health to the afflicted. It was in the year 1858 
that Dr. Rudolph Virchow delivered his first lectures 
on "Cellular Pathology," advancing the theory of cell 
life and the nature of all vital processes. This was the 
first step forward to evolve and demand the application 
of electricitv, manual and vibratorv massage, lisrht, and 
other means to promote, stimulate and restore new cell 
life. It is only within recent years that Koch's re- 
searches in bacteriology and the discovery of the 
tubercle bacillus which has made his name immortal. 
When this scientist announced that the bacillus of the 
"Great W T hite Plague'' could not exist when exposed 



PHYSIOTHERAPY, 



21 




MOTOR POINTS OF FACE AND NECK. 



1. Frontalis. 

2. Facial nerve (super.). 

3. Corrugator supercil. 

4. Orbicularis palp. 

5. Nasal muscles. 

6. Zygomatici. 

7. Orbicularis oris. 

8. Facial nerve (med.). 

9. Masseter. 

10. Levator menti. 

11. Quadratus menti. 

12. Triangularis menti. 

13. Hypoglossal nerve. 

14. Facial nerve (infer.). 

15. Platysma myoides. 

16. Hyoid muscles. 

17. Omohyoideus. 



IS. 



Ext. ant. thoracic nerve (pectoralis 

major). 
Phrenic nerve. 
Fifth and Sixth cerv. nerves (del- 

toideus, biceps, brachialis, su- 

pin. longus). 



21. Brachial plexus. 

22. Long thoracic nerve (serratua 

magnus). 

23. Circumflex nerve. 

24. Dorsalis scapulae nerve (rhom- 

boidei). 

25. Trapezius. 

26. Levator anguli scapulas. 

27. Spinal accessory nerve. 

28. Sterno-mastoideus. 

29. Splenius. 

30. Facial nerve (inf. branch). 

31. Facial nerve (med. branch). 

32. Post, auricular nerve. 

33. Facial nerve (trunk). 

34. Facial nerve (sup. branch). 
?5. Temporalis. 

S6. Third frontal convol. and insula 

(centre of speech). 
37. Ascend, front and pariet. convo!. 

motor area). 



22 



PHYSIOTHERAPY 



to the sun's rays he revolutionized all previous methods 
of treatment. Although in the past this disease has 
caused more deaths than all the wars of the nations, 
these sufferers can now look heavenward and behold 
two of the greatest healing agencies nature has ever 
given to man — the sun and the pure air enriched with 
oxygen. It is largely the researches of modern physi- 




1IOTOR POINTS OF INNER ASPECT OF LEFT ARM. 



1. 


Triceps (cap. long.). 




13. 


Flex. poll. brev. 


2. 


Triceps (cap. intern.). 




16. 


Opponens pollicis. 


3! 


Ulnar nerve. 




17. 


Abductor pollicis. 


4. 


Flex, carpi ulnaris. 




IS. 


Median nerve. 


5. 


Flex. dig. com. prof. 




19. 


Flex. poll, longus. 


6. 


Flex. dig. (II et III) subl. 


20. 


Flex. subl. digit. 


7. 


Flex. dig. (ind. et min 


) subl. 


21. 


Flex, carpi radialis. 


8. 


Ulnar nerve. 




2 9 . 


Pronator radii teres. 


9. 


Palmaris brevis. 




23] 


Supinator longus. 


10. 


Abductor dig. min. 




24. 


Median nerve. 


11. 


Flexor dig. min. 




25. 


Brachialis anticus. 


12. 


Opponens dig. min. 




26. 


Biceps. 


13. 


Lumbricales. 




27. 


Musculo-cutan. nerve. 


14. 


Adductor poll. brev. 




28. 


Deltoideus (ant. port.) 



ology, physiological chemistry and bacteriology which 
have demanded the abandoning of drugs in the treat- 
ment of many diseases; and although drugs will always 
bear their respective influence in the treatment of dis- 
ease, they are not capable of mastering all pathological 
conditions alone, and the "physiologic methods" are 
rapidly and legitimately winning their way into favor 
in modern therapeutics. 



PHYSIOTHERAPY. 



23 



In order that the reader may form a clear concep- 
tion of the nature of physiotherapy I quote the follow- 
ing from an editorial in the American Journal of Phy- 
siologic Therapeutics: ''The modern conception of dis- 
ease regards it no longer as a concrete entity to be 
forcibly driven out nor as the objective clash of con- 
tending elements across the passive arena of the pa- 
tient's body; but as the interplay of action and reaction 



MOTOR POINTS OF OUTER ASPECT OP LEFT ARM. 




1 Deltoideus. 

2 Musculo-Spiral Nerve. 

3 Brachialis Anticus. 
4' Supinator Longus. 

5 Extens. Carp. Rad. Long. 

6 Extens. Carp. Rad. Brev. 

7 Extens. Comm. Digit 
S Extens. Indicis. 

9 Ext. Oss. Metac. Poll. 

10 Ext. Prim. Intern. Poll. 

11 Interossei Dorsal. 

12 Interossei Dorsal. 
13' Abduct. Min. Digiti. 

14 Ext. Sec. Intern. Poll. 

15 Extens. Indicis. 

16 Extens. Min. Digiti. 

17 Supinator Brevis. 

IS Extens. Carpi. Ulnar. 

19 Triceps. 

20 Triceps. 



between the whole organism and its environment— a 
dynamic affair of perverted reaction to stimulus. Un- 
der this conception of disease, it is inevitable that our 
conception of therapeutics should become similarly 
dynamic and reactionary. Rational therapy no longer 
aims to force action, whether of drugs or of anything 
else, upon the organism, but to arouse proper reaction 
within it, in which the whole organism must partici- 



24 



PHYSIOTHERAPY. 



pate. This is Physiologic Therapeutics in its broadest 
and profoundest sense. And it calls forth, as its ma- 
teria medica, every means and agency which experience 
has shown certain, or reason renders likely, to bring 
about such desired and adequate reaction. 

It is not denied that drugs may, and in many in- 
stances do, come within the range of this conception of 
therapeutics. Certainly there is no intention of sug- 




MOTOR POINTS OF POSTERIOR ASPECT OF 
LEFT THIGH AND LEG. 

1. Sciatic nerve. 

2. Biceps femoris (cap. long.). 

3. Biceps femoris (cap. brev.). 

4. Peroneal nerve. 

5. Gastrocnemius (cap. ext.). 

6. Soleus. 

7. Flexor hallucis long. 
S. Tibial nerve. 

9. Flexor digit, comm. long. 

10. Soleus. 

11. Gastrocnemius (cap. int.). 

12. Posterior tibial nerve. 

13. S'emi-membranosus. 

14. Semi-tendinosus. 

15. Adductor magnus. 

16. Gluteus maximus. 



gesting that therapeutics can dispense with drugs — not 
in our lifetime, at all events. But there are several 
reasons why drugs do not most fitly represent, or most 
readily identify themselves with, dynamic therapeutics. 
For one thing, we have used them so long for their 
pharmacological effect, that practically all of our drug 
therapeutics must be learned over again to adapt it to 
dynamic therapy. For another, our control of drug ac- 
tion, while it is much more accurate than it used to be, 
is still, and must in the nature of things continue to be, 
too uncertain to compete, in physiologic results, with 



PHYSIOTHERAPY. 



25 



the drugless modes. But of far deeper import yet is 
the fact that drug therapy does not represent the same 
degree of proximate principle in therapeutics that these 
other modes do. That is to say, the latter constitute a 
group of therapeutic agents "existing ready formed" (as 
we say of chemical proximate principles) and available 
for application by means which do not alter or destroy 
their complex unit of potentiality. 

The whole future of therapeutics is without doubt a 
question of body defense — in which are to be included, 




MOTOR POINTS OF OUTER ASPECT OF 
LEFT LEG. 

Tibialis anticus. 
Extens. digit, longus. 
Peroneus brevis. 
Extens. hallucis longus. 
Interossei dorsales. 
Abductor min. digiti. 
Extens. digit, brevis. 
Flex, hallucis long. 
Soleus. 

Peroneus longus. 
Gastrocnemius. 
Peroneal nerve. 



not alone the phagocytic defenses of the blood, as ex- 
emplified in the sera and vaccines, but all the natural 
or acquired processes of functional reaction by which 
the organism, or any part of it, defends itself against 
disease and death. This is Physiologic Therapeutics, 
in its broad intent. It is not a mere arbitrary fad in 
medicine that has created a new class of materia medica 
and labeled the "physiologic methods," in distinction 
from drug remedies; not a passing vogue that has given 
these methods accuracy. It is that, in the unfolding 
of the new dynamic concept of disease, and the conse- 



26 



PHYSIOTHERAPY. 



quent search for a corresponding system of therapy, 
medicine has been obliged to transcend the realm of 
drugs and to cultivate a field of therapeutics which 
afforded, as stated, a more proximate principle of dyna- 
mic reaction. And this field constitutes the class of 
so-called drugless or physiological remedies. 

We do not belittle the place of drugs in medicine. 
It is probable that they will play an important role in 
therapeutics. But we unhesitatingly predict that the 
principle of Physiologic Therapeutics, as we have 




MOTOR POINTS OF INNER 
LEFT THIGH. 



.SPECT OF 



1 


Crural Nerve. 


2 


Obturator Nerve. 


3 


Pectineus. 


4 


Abductor Magnus. 


5 


Abductor Longus. 


6 


Cruralis. 


7 


Vastus Internus. 


^ 


Vastus Externus. 


9 


Rectus Femoris. 


1G 


Quardiceps. 


11 


Sartorius. 


12 


Tensor Vag. Femoris. 



briefly tried to expound it, will dominate the spirit and 
practice of medicine of the future — even of the near 
future.'' 

Taking from this the basic principles of physiologic 
therapeutics as a "defense against disease." we find the 
physical methods far superior to drugs in many dis- 
eases. Where can we find a drug in the Materia 
Medica that will produce the reaction upon muscular 
and nerve fiber to compare with electricity? "Where is 
there a drug that will compete with light and heat, 
relative to its influence upon the skin and bacteria, and 



PHYSIOTHERAPY. 27 

so on through the entire chain of physical methods of 
defending the body from the invading enemy — disease? 

These methods have been classified under different 
names and systems, ' incorporating electricity, hydro- 
therapy, phototherapy, mechano-therapy, thermother- 
apy, vibrotherapy, osteopathy, massage, physical train- 
ing and all the kindred sciences Many of these sys- 
tems are so closely allied as to involve many of the 
fundamental principles ; each has its independent thera- 
peutic action however, inasmuch as the vaso-motor cen- 
ters of the body enter largely into the basic principles 
of this field of practice I have inserted among the 
foregoing pages illustrations outlining these centers, 
which are of the greatest value to the physiotherapeu- 
tist 

It is an easy matter to locate these centers when 
you are in a dissecting room, where the map portray- 
ing the geography of the body is before you, but when 
this is covered by the integument, these land marks 
are more obscure I have also tried to illustrate the 
following chapters with drawings that each chapter 
will be easily comprehended 

In conclusion, I will add if there is any one course 
to create harmony among the sectarian schools of med- 
icine and promote a united medical profession, it is 
physiologic therapeutics 

The allopathic physician will cease to pseudonym 
the homeopath a ''dispenser of imagination" and the 
homeopath and eclectic will not refer to the allopath as 
a member of the "dominant school of medicine," but 
all will unite in one tenet, and 

"Live for those who love you, 
And those who know you true ; 
For the heaven that smiles above you, 
And the good that you can do" 



28 



THERAPEUTICS OF LIGHT. 



Therapeutics of Light 



Ever since the sun's rays have been shining upon 
the face of the earth we have been in possession of the 
oldest and one of the greatest natural healing agencies, 
and although all animal -life has recognized the influ- 
ence of light and 
heat from instinct, 
as a therapeutic 
measure, it has only 
been within the last 
few years that the 
scientific principles 
of the therapeutics 
of light have been 
investigated and 
utilized to any great 
extent by the med- 
ical profession. It 
was in the year 1895 
that Roentgen an- 
nounced the results 
of his investigation 
of the X-ray, and, 
in the same year, 
Finsen treated and cured his first case of lupus by the 
ultra-violet rays. It we would visit the grounds of the 
All-Denmark Hospital in Copenhagen, we would see 
erected a national monument to the memory of Nils 
Finsen, whose investigation into the effect of light 
upon the human body has brought hope and relief to 
thousands of suffering humanity. His discovery has 
marked a definite step forward in medical science, and 
in this beautiful memorial (see cut), entitled ''Towards 
the Light" is produced three figures straining toward 
the light to regain their health. 




THERAPEUTICS OF LIGHT. 



29 



Finsen's investigations were followed by Arloing 
d'Arsonval DuBoise, Geisler, Graber, Bert and others ; 
today the utility of light is recognized as one of the 
indispensable physiologic means of treating and curing 
disease. 



' 




* J 


-am 






iQl& 




At *v5D 

m 






1 




\ ■■ ■ ■ I '■■.-'..; ■■ 


% 






4- 


J 




. ■ Style ';F Special'*. 

>.■ . 500 Candle, JPower 




/ 



LEUCODESCENT THERAPEUTIC LAMP. 



THERAPEUTIC LIGHT APPARATUS. 

One of the most important requisites to conduct 
light treatments, is a well constructed lamp. The Fin- 
sen light which is so well and favorably known is too 



30 THERAPEUTICS OF LIGHT. 

elaborate and expensive for the general practitioner; we 
will, therefore, only consider the incandescent and arc 
lights, which are easy to operate and uncomplicated in 
their technique. The lamp for all general purposes 
should be capable of producing light energy, which will 
be equivalent to from 300 to 500 candle-power, and 
ninety per cent of the lamps in use are of the stronger 
light power. The volume of light and heat should be 
easily regulated to suit the requirements for different 
diseases, and also economize in the operation of your 
lamp. The lamp should also be capable of adjustment 
to any angle, that the patient may receive treatments in 
either the sitting or recumbent position. Colored 
screens should also be provided for those who desire to 
test some of the claims made for colored light in ther- 
apeutic work; with these few considerations you will 
have a light to conduct your work which will be satis- 
factory at all times. I am personally impartial to all 
lamps, but my experience has been confined to the 
leucodescent lamp, manufactured by Spear-Marshall 
Co., Chicago, and the solar therapeutic arc lamp, man- 
ufactured by the Good Health Publishing Co., Battle 
Creek, Mich. 



CLASSIFICATION OF LIGHT RAYS AS USED 
IN THERAPEUTICS. 

If we would observe the colors of the rainbow, or 
take a prism, (cut diamond), and bring its reflection 
against a screen, we would see the seven primary colors 
which constitute the spectrum — red, orange, yellow, 
green, blue, indigo and violet — although in reality there 
are an enormous, if not an indefinite number of colors 
in the spectrum, but for convenience of classification 
and therapeutic purposes, they have been divided and 
subdivided into the following classes: 

Thermic or Heat Rays — Red and infra-red. 

Luminous Rays — Orange, yellow and green. 

Chemical or Actinic Rays — Blue, indigo, violet and 
ultra-violet. 



THERAPEUTICS OF LIGHT. 



31 




THE SOLAR THERAPEUTIC ARC LAMP. 



32 THERAPEUTICS OF LIGHT. 

It will thus be seen that all the rays of light except 
the infra-red and ultra-violet are within the visible 
spectrum. 

Finsen's original theory was that the curative value 
of light was greatest at the ultra-violet end of the spec- 
trum; although he did not entirely ignore the value of 
the remaining rays in certain indications. The Finsen 
apparatus for light treatment, however, is designed with 
a view of producing light with the greatest possible 
number of ultra-violet rays, and the elimination, largely, 
of the remaining rays of the spectrum ; this is the rea- 
son the blue, indigo, violet and ultra-violet rays are 
often referred to as the Finsen rays. 

The chemical or actinic rays, the luminous and ther- 
mic or heat rays, each, apparently, have their individual 
therapeutic action but their value is not destroyed when 
used as a unity. In classifying the therapeutic value of 
the light rays there has been some diversity of opinion. 

Freund has gone so far as to exclude the thermic 
rays from the therapeutic field, which is a great omis- 
sion, as heat combined with light is indispensable in 
the treatment of many conditions ; that each color of 
the spectrum bears an important therapeutic value is 
beyond question and has the endorsement of the most 
constant observers. 

In resuming the utility of light as a healing agent, 
the light rays have been classified as follows: 

Chemical or Actinic Rays, find their greatest field of 
usefulness in the destruction of bacteria and their anti- 
septic effect ;. when used alone they are superficial in 
effect, and will not penetrate below the skin's surface, 
hence various devices have been used to increase their 
penetration. The. blood in the tissues absorbs the pen- 
etrating power, and when this is forced out by pressure, 
and other means, their influence is more active; these 
rays are depended upon for their bacteriacidal influence 
in all forms of superficial septic and suppurative dis- 
eases ; lupus, acne vulgaris, eczema, epitheloma and 
kindred affections, and when combined with other light 



THERAPEUTICS OF LIGHT. 



33 



rays, reinforces their action in the treatment of more 
deeply seated diseases. 

The Luminous Rays bear their greatest influence 
upon nutritional centers, increasing the number of red 
blood corpuscles ; they also increase the percentage of 
valuable in all diseases where there is a wasting of tis- 
sue. The central rays of the spectrum are also seda- 
tive to nerve tissues. 



cat Action 



Leucoclescent Rays 



Most Active . Most Powerful Ch 

^Analgesic Ef*«ct/\NjUtrjtlo«ai. Center/ \. and Bactericidal Effect S 




— > 



RAYS OF THE SPECTRUM. 



Dr. Schlanger has demonstrated that green and blue 
light would quiet maniacs when other means would 
fail ; he therefore provided a room with green and blue 
windows for this sedative effect. Anaemia chlorosis and 
other deficiencies of the blood and tissues are greatly 
benefited by the luminous rays. 

The Thermic or Heat Rays — It is the penetrating 
qualities of the vibratory energy of the red and infra- 
red rays, used in conjunction with other rays that assist 
their therapeutic action in deep-seated affections, if 
combined with heat, and the unity of the other rays of 
the spectrum with the therapeutic lamp. Radiant heat 
rays' greatest influence is as an anodyne and analgesic 
and to obtund pain it is therefore the therapeutic agent 
used. 



34 THERAPEUTICS OF LIGHT. 

EFFECTS OF LIGHT UPON ANIMAL TISSUES. 

Light and heat have always been symbolical of life, 
while cold and darkness have been emblematic of decay 
and death; we find the highest forms of animal and 
vegetable life thriving under the influence of heat and 
light and, usually, the lowest forms existing in cold and 
darkness. The effect of light, therefore, seems to vital- 
ize all tissues and functions of the body ; nearly all 
observers agree that the following histological changes 
occur in the tissues exposed to the light, viz., it in- 
creases the activity of all tissue cells, and produces a 
pronounced dilatation of the superficial and deep cutane- 
ous blood vessels; the migration of the leucocytes and 
swelling of collagen hyperplasia of the epidermis and 
thickening of the rete mucosum. The influence of light 
upon blood vessels and circulation tends to increase the 
circulation and remove effete material, and bears the 
same relation as a mustard plaster or hot fomentation 
and chemical irritants. The cutaneous glands are stim- 
ulated and profuse perspiration ensues, likewise encour- 
aging the eliminative process-. That combined light 
and heat is more active than heat alone is exemplified 
in the electric light bath, which is nearly twice as ac- 
tive in producing perspiration, although the electric 
light cabinet may be at a lower temperature than the 
hot air or vapor bath cabinet. 

Metabolism is also greatly stimulated by the effect 
of light rays impinging upon the nerve endings of the 
skin, oxidation is greatly increased through the influ- 
ence of light and the hemoglobin of the red cells is 
enriched by its absorption. When we realize the rap- 
idity in which the blood circulates and the compara- 
tively short time required for the entire volume of 
blood to pass through a given surface, exposed by a 
therapeutic lamp, we can appreciate the value of light 
in destroying phagocytic bacteria and the elimination 
of waste and diseased material. 



THERAPEUTICS OF LIGHT. 



35 



The chemical r.ays of lights are more germicidal in 
their action than many drugs. They will destroy 
tetanus germs more rapidly than a one to one thousand 
bichloride of mercury solution. Koch and Kitasato 
have proven that tubercle and plague bacillus perish 
on exposure to the sun and the same is true regarding 
the destruction of bacillus of other diseases. There 
is a difference of opinion as to how the bacteria is 
destroyed; some claim it is due to the changes in the 
tissues, caused by the light and others that it is the 
direct influence of the ultra-violet ravs. 




COLOR SCREEN ATTACHED TO ARC LAMP. 

LIGHT AS A THERAPEUTIC AGENT. 

In the application of light as a therapeutic agent, it 
is absolutely necessary that the rays of light should be 
applied directly to the bare skin, as any covering, how- 
ever thin it may be, will retard the influence of the 
light rays. Any surrounding surface not requiring the 
influence of light should be covered with dark cloth. 
After adjusting the lamp so that the rays will fall 
directly upon the surface to be treated, the current is 
increased to reach the degree of light desired, and each 
treatment timed to meet the requirements of individual 



36 THERAPEUTICS OF LIGHT. 

cases. Blondes- are more susceptible to the influence of 
light than brunettes, owing to the lack of pigment in 
their skin, and it is well to explain to all new patients 
that erythema will be a possible consequence. The 
first few applications should, therefore, be of short 
duration ; from two to five minutes will generally pro- 
duce a slight reddening of the skin. As each patient 
progresses the duration of the seance may be prolonged 
until from fifteen to thirty minutes is required to pro- 
duce the desired effect; there will be sufficient pigment 
matter formed to protect the tissues and prevent injury. 
For all general purposes the full unmodified rays of 
light are employed, as we thus receive the derivative 
effect of all the rays, if we wish to eliminate the chem- 
ical rays and increase the thermic rays the red screen 
is used and likewise the blue screen is used to some- 
what eliminate the thermic rays, and increase the 
chemical rays. 

The principal and most active qualities of light as a 
therapeutic agent may be found in its influence upon 
the blood and circulation, its tonic and vitalizing powers 
and its- destruction of many pathogenic germs. If we 
would resume the diseased conditions in which this 
form or treatment is applicable we would appreciate the 
large field of usefulness this agent is destined to All in 
the treatment of disease. All superficial diseases are more 
rapidly influenced, owing to the direct action of this agent. 
Deep seated disease, often, can only be influenced indi- 
rectly, or by reflex action. Pain and nerve pressure 
are relieved by inducing activity of the circulation, 
through the congested areas; therefore, all superficial 
inflammation and suppuration are greatly benefited. 
This has been demonstrated through the benefits and 
cures derived in longstanding cases of acne vulgaris, 
scrofulous, abscesses, and ulcerating lupus. By expos- 
ing these diseases to the influence of the powerful ultra- 
violet rays, as close as possible to diseased surface, for 
a definite period, we will observe that the influence of 
this agent will diminish, and in time, remove the inflam- 
matory process, by improving the circulation and de- 



THERAPEUTICS OF LIGHT. 37 

stroying the suppurating process, through its chemical 
action and bacteriacidal power. 

Axmann states that fresh and suppurating wounds 
behave under the influence of the actinic rays as if they 
had been bathed with a solution of peroxide of hydro- 
gen. It will thus be seen what a large field of useful- 
ness light has in the treatment of cutaneous and all 
ulcerative affections alone, although its usefulness is 
not limited to the skin, as the influence of light upon 
the deeper structures is almost unlimited. Its power 
to relieve high blood pressure exercises its potency in 
a variety of painful affections, — rheumatism, neuralgia, 
neuritis, pleurisy and allied diseases are treated with 
excellent results. 

While superficial affections depend upon the direct 
rays of light for their therapeutic value, the deeply 
seated organs are influenced, in a remote way, through 
terminal nerve action, and the influence of the blood 
and the circulation. If we produce an erythema of the 
entire surface of the body, as we would by exposing the 
entire body to a sun, electric light, or full hot water 
bath, we are capable of drawing to the cutaneous sur 
face one-half to two-thirds of all the blood in the body, 
we are, therefore, temporarily removing the blood 
supply and pressure from the internal organs, which 
will readily be seen to have its influence in eliminating 
inflammatory conditions of the liver, spleen, kidneys, 
lungs and other internal organs. This may be done 
more rapidly by the hot water bath, but the continued 
influence of the light and heat received by the electric 
light or sun bath treatments are most lasting in their 
results ; to illustrate, we may relax a convulsion caused 
by a congested spine or brain more rapidly by placing 
the patient in a hot water bath, as this is an acute 
affection, but in an old, chronic affection of these 
organs, permanent relief could only be obtained by long 
exposure, resulting in actinic or solar erythema. On 
the other hand, we find certain surfaces of the skin are 
related to the blood supply of certain internal organs, 



38 THERAPEUTICS OF LIGHT. 

and by applying light to these surfaces, we influence 
more directly the internal organs ; in much the same 
way as the manipulation of the nerve centers in the 
spinal column bears its influence in treating internal 
organs by Osteopathy and Vibratory massage. For 
instance, the skin covering the loins is, collaterally 
related to the kidneys, through the renal branches of 
the lumbar arteries ; therefore, by producing hyperemia 
of the skin, at this surface, we are inducing a collateral 
anaemia and relieving blood pressure upon the kidneys. 
The entire surface of the body is likewise collaterally 



EXPLANATION OF ANTERIOR VIEW. 

This illustration, showing the anterior view of the 
body, points out the cutaneous areas when the applica- 
tion of light is utilized to have its most direct influence 
upon the internal organs. The line or circle outlining 
and incorporating these areas is the surface in which 
the rays from the therapeutic lamp should exert their 
greatest therapeutic value, (1) Larynx and Pharynx, (2) 
The Lungs, (3) The Heart, (4) The Stomach, (6) The 
Liver, (7) The Spleen, (8) The Intestines and Abdom- 
inal Viscera, (9) Bladder, Uterus and Ovaries, (10) 
Genito-Urinary Organs 



related to different organs, and the relationship between 
the integument and internal organs .is of the greatest 
importance in the therapeutics of light and are the 
land-marks used by the light therapeutist in the treat- 
ment of disease. 

As a rule, the skin covering the internal organs is 
reflexly related to the organs it covers, both anterially 
and posterially, although there are many exceptions to 
this rule. To illustrate : the soles of the feet have a 
reflex action upon the brain, genito-urinary organs and 
bowels, while the dorsal area of the feet has a reaction 
upon the pelvic organs, brain and intestines, and the 



THERAPEUTICS OF LIGHT. 



39 




ANTERIOR LIGHT AREAS. 



40 THERAPEUTICS OF LIGHT. 

light area of the hands is directly related to the brain 
and lungs. This has been demonstrated by removing 
headache; also, congestion of the brain and lungs by 
applying hot applications to the hands and feet, by hot 
water baths, etc. 



EXPLANATION OF POSTERIOR VIEW. 

This illustration gives the cutaneous areas and spinal 
centers through which the application of light exerts 
its greatest therapeutic influence, through the nerve 
centers. 

(1) The Brain, Larynx and Pharynx, (2 and 3) The 
Heart, (4) The Lungs, (5) The Stomach, (6) The 
Liver, (7) The Spleen, (8) The Intestines and Abdom- 
inal Viscera, (9) The Bladder, Uterus and Ovaries, (10) 
Genito-Urinary Organs. 



TECHNIQUE OF LIGHT THERAPEUTICS. 

By referring to the accompanying translucent illus- 
trations, it will be seen where the application of light, 
by the use of the therapeutic lamp, is applied to estab- 
lish its direct influence, and collateral reflex action 
through the circulatory and nervous systems. The 
skin and spinal centers are used as a means of convey- 
ing therapeutic impressions through the direct and 
peripheral nerves, and controlling circulation by its in- 
fluence upon the blood vessels. Every area of the cu- 
taneous surface, and each nerve center in the spinal 
column, is in special reflex relation with some internal 
organ. The following are the most important of these 
reflex relationships. 

The circumscribed areas in these illustrations are 
the ones associated reflexly with the deep seated or- 
gans, and also illustrate the focusing surface, which the 
light could cover by its reflection of the direct rays ; 
the intensity of the light may be either increased or 
decreased as desired, either by moving the reflector to 



THERAPEUTICS OF LIGHT. . 41 




POSTERIOR LIGHT AREAS. 



■42 THERAPEUTICS OF LIGHT. 

or from the surface, or the more economical way of reg- 
ulating the current by the rheostat. 

In making application to the chest, there are two 
particular precautions which should be observed to pro- 
tect the eyes from the powerful rays, by the use of col- 
ored glasses, or a dark cloth shield around them, and 
in very feeble patients, where the heart is affected, the 
entire surface of the heart should be covered with a 
damp, dark cloth, or other protection. 

The application of light to the chest and sbdruuinal 
surface is indispensable in a large number of diseases. 
All forms of pain will find relief; intercostal neuralgia, 
pleurisy, acute bronchitis and pneumonia will be greatly 
benefited by these applications, which should be of 
short duration but rather intense in character. In all 
chronic diseases the treatment should be prolonged for 
a greater period, with a view of producing erythema. 
What is applicable to the chest is also useful in treat- 
ing the epigastric, hepatic, and lower abdominal regions. 
Application of light varying from five to fifteen minutes 
will relieve pain and inflammation in the stomach, liver 
and bowels and by maintaining a continued hyperemia 
of the skin is one of the most beneficial factors in the 
treatment of all chronic affections of the diseased thor- 
acic and abdominal organs. 

Application of light to the spine, and spinal centers 
acts in both a direct and indirect way. It will bring 
relief to diseases within the cord or vertebrae, neuritis 
or Pott's disease or reflex pains from the internal or- 
gans. Gastritis, gall bladder disease, and the so-called 
preferred pains of the other viscera. A continued hy- 
peremia of the areas given in the accompanying illus- 
trations is one of the most effectual means of pain 
inhibition in the therapeutic field. These special or- 
gans can be specifically treated by- the following brief 
technique : 

The Brain — The skin covering the entire scalp and 
face, and the back of neck, also the feet and hands are 
the areas used in treating this organ. 



THERAPEUTICS OF LIGHT. 43 

The Larynx and Pharynx are reflexly influenced by 
the skin in the front and back of the neck, and upper 
cervical nerve centers in the spinal column. 

The Lungs — The skin in front and back of these or- 
gans and the vertebral area from the first to the sixth 
dorsal vertebrae, and also the skin on the inner sur- 
face of the thighs have special reflex relation with the 
lungs. 

The Heart — The skin and area of the chest wall cov- 
ering the heart in front and behind, and also the first, 
second and third dorsal vertebrae are the centers in- 
fluencing the heart. 

The Liver — The integument lying over the organ and 
the area from the seventh to the tenth dorsal vertebrae. 

The Stomach — Direct application of light to the skin 
covering the stomach and also the vaso-motor centers 
from the sixth to the ninth of the dorsal vertebrae. 

The Spleen — The skin on the left side of the lower 
chest, and the nerve centers from the third to the 
eighth dorsal vertebrae are associated with this organ. 

The Intestines — Are reflexly related to the skin 
which covers them and the vertebral area from the 
seventh dorsal to the first lumbar vertebrae. 

The Kidneys — The skin at the lower part of the 
sternum and the area involved from the tenth dorsal 
to the second lumbar vertebrae. 

Bladder Uterus and Ovaries — The skin covering these 
organs and also the groins is directly related to the 
above organs in the female, and also to the prostate 
testis and epidermis of the male ; their spinal centers 
are from the eleventh dorsal to the fifth lumbar verte- 
brae, inclusive. 

REGIONAL APPLICATION OF LIGHT. 

Regional application of light and heat can be 
brought in direct contact to every given area by means 
of the incandescent or arc lamp, and these are the 
means used when a greater degree of intensity is de- 
sired. 



44 THERAPEUTICS OF LIGHT. 

In treating local or internal diseases by reflex action, 
after adjusting the lamp so the parallel rays will fall 
directly upon the diseased surface', the intensity of the 
light may be regulated, either by regulating the cur- 
rent, or the distance at which the lamp is placed from 
the patient. When a very small area is desired to be 
treated, such as lupus or small skin lesions, the lamp 
can also be focused in such a way as to concentrate 
the rays to a very small area or diameter. The first 
indication that we are receiving the benefits of the 
treatment is a very decided sensation of heat; this is 
followed, in a few minutes, by a reddening of the skin, 
and the beginning of perspiration, which indicates that 
the full benefit of the application has been secured. If 
the patient complains of the intense heat, the surface 
may be sponged with tepid water, alcohol or other 
liquids. 

Solar erythema or light burn is a condition which 
occurs after continued use of the light treatments, and 
is due to the actinic rays of light, and denotes a com- 
plete dilatation of the cutaneous blood vessels ; no 
great harm can be done with this treatment, as. with 
X-ray, because the effect is only superficial. Continued 
treatments produce a discoloration of the pigmentary 
layer of the skin, which is analogous to sunburn and 
the tanning process from the sun's rays. This extreme 
light force is a condition frequently desired in the 
treatment of many deep seated and obstinate cutaneous 
diseases; in gall stones, sclerosis of the liver and 
chronic gastric catarrh, appendicitis, all internal con- 
gestion and painful joint affections, sciatica, chronic 
acne, eczema, psoriasis, etc. 

APPLICATION OF LIGHT TO NERVE TRUNKS. 

This is one of the most effectual means of obtund- 
ing pain in all diseases involving the sciatic and other 
nerve trunks ; it is, therefore, indispensable in the treat- 
ment of sciatic rheumatism, neuritis, locomotor ataxia, 
etc. 



THERAPEUTICS OF LIGHT. 45 

APPLICATION OF LIGHT TO JOINTS. 

This affords a very potent means of treating joint 
affections, whether due to injury or disease; sprained 
ankle, rheumatic joint affections, articular rheumatism, 
etc., yield very readily to this form of treatment. 



APPLICATION OF LIGHT TO THE EPIGASTRIC 
REGION. 

Will prove valuable in the treatment of all chronic 
diseases of the stomach, gastralgia, dyspepsia, chronic 
gastric catarrh, duodenitis, cholangitis, etc. To pro- 
duce marked results in these diseases, the epigastrum 
should be kept in a continued state of hyperemia of 
the skin. 



APPLICATION OF LIGHT TO THE HEPATIC 
REGION. 

This is one of the treatments par excellence in many 
long standing diseases of the liver; the treatment 
should be continued until a permanent hyperemia ex- 
ists, covering the entire surface of the liver, which will 
render valuable service in the treatment of gall stone 
disease, chronic congestion, jaundice, and cirrhosis of 
the organ. It creates activity of the portal circulation 
and induces the flow of bile. 



APPLICATION OF LIGHT TO THE ABDOMINAL 
REGION. 

The application of light to this region greatly in- 
fluences nearly all diseases occurring within the abdom- 
inal cavity; relieves pain in intestinal colic, chronic 
colitis, chronic appendicitis, visceral neuralgia, and all 
inflammatory and non-inflammatory and painful condi- 
tions. 



46 



THERAPEUTICS OF LIGHT. 



APPLICATION OF LIGHT TO THE RENAL 
REGIONS. 

By applying light directly to the renal region in the 
back, we derive a most direct influence upon the kid- 
neys, and increase their activity and eliminative func- 
tions; this is, also, a very effective therapeutic measure 
in the treatment of all acute and chronic diseases of 
these organs. Their attachment is so closely related 
to the external surface and spinal centers that the most 
active influence is derived from light in this region. 




APPLICATION OF LIGHT TO SPINAL AREAS. 



APPLICATION OF LIGHT TO THE LOINS. 

It is surprising to note the rapidity in which light 
treatments will remove "kinks" in the back; backache, 
and lumbago will often disappear like magic with this 
treatment. Its reflex action, through the nerve trunks 
in this location, has a wide field of usefulness in the 
treatment of a variety of diseases, incorporating nearly 
all the abdominal and pelvic organs, and also diseases 
within the spinal cord ; spinal cirrhosis, chronic myelitis, 



THERAPEUTICS OF LIGHT. 47 

etc. It is also the region in which the greatest results 
are obtained in genito-urinary diseases, neuralgia, acute 
inflammation of the bladder; also, neurasthenia in both 
sexes, amenorrhea, ovarian neuralgia, salpingitis, chronic 
metritis, and dysmenorrhoea and other pelvic and ab- 
dominal pains are generally relieved by this treatment. 

GENERAL LIGHT TREATMENT. 

ELECTRIC LIGHT BATH. 

Of all the different forms of photo and thermother- 
aphy, which have been devised, the electric light bath 
has the greatest field of usefulness, and no physician 
conducting an office practice or sanatarium armamen- 
torium would be complete without an electric light bath 
cabinet, for this is the one means of giving the entire 
body the benefit of light and heat, in its most potent, 
convenient and beneficial form. This bath was intro- 
duced by Dr. Kellogg, of the Battle Creek Sanitarium, 
about twenty years ago, and its general approval and 
scope of usefulness is apparently increasing every day, 
while extensive investigations have been conducted to 
obtain the physiologic effects of the procedure. This 
bath, as a rule, is not conducted with a view of treat- 
ing any special organ, but for its general tonic and elim- 
inative influence ; in this, it has no superior. Its stim- 
ulative action upon the skin is nearly double that of the 
Turkish or Russian bath, as free perspiration will take 
place in three and one-half minutes, at a temperature 
of 80 degrees F., while it requires about six minutes in 
the Turkish and Russian bath at a temperature from 
102 degrees F., to 128 degrees F. Another advantage 
over other baths is that the heat may be retained at any 
desired degree, by simply controlling the lights. The 
greatest value of this treatment is the easy way in 
which it induces perspiration as an eliminative process. 
Brain workers and confined office attendants are the 
ones who most need the best influences derived from 
both heat and light, as exemplified in the electric light 
bath. The influence of this treatment in the elimination 
of marked toxic accumulations far excels any other 



48 



THERAPEUTICS OF LIGHT. 



means, and will not only be found useful as a hygienic 
luxury, but a therapeutic necessity in treating many 
conditions. It is by far the best eliminative means of 
removing toxic influences from alcohol and the drug 
habit, and the toxemia of chronic dyspepsia, malarial 




ELECTRIC LIGHT BATH CABINET. 



cachexia, rheumatism, syphilis and other diseases of a 
kindred nature ; while the light, combined with heat, re- 
inforces its influence upon cell growth, and establishes 
new activity in the blood and circulatory system. It is 
the most potent therapeutic agent known to promote 
activity of the skin in the elimination of waste pro- 
ducts. 



HYDROTHERAPEUTICS. 



49 



Hydrotherapeutics 



Other than light baths, constitute one of the most 
ancient of therapeutic measures, and the healing prop- 
erties of water could be traced back to the most re- 
mote ages of antiquity. The ancient Romans not only- 
utilized baths as a panacea for all ills, but as a means 
of invigorating and strengthening their armies, and 

wherever their subjects 
were stationed, elaborate 
bath a c c o m m o dations 
were installed. The gi- 
gantic magnitude of 
these establishments is 
well illustrated in the 
ruins; of the baths of 
Caracella, whic'fy are still 
in existence. Similar 
baths were located in its. 
most distant possessions. 
In the ancient city of 
Bath, England, there was 
a Roman bath establish- 
ment restored only three 
years ago, A. D. 1909, as 
it existed during the time 
of Caesar. The baths of 
Rome and Roman possessions finally lost their signi- 
ficance, and for many centuries the art of bathing, 
as formerly practiced, fell out of existence ; and only 
within the last sixty years has the therapeutic value of 
baths evolved into a scientific system of hydrotherapy. 
The scientific technique of hydrotherapy, as it is 
practiced today, supplemented by the use of all modern 




RUINS OF THE BATHS OP 
CARACELLA 



50 HYDROTHERAPEUTICS. 

bath apparatus, places hydrotherapy among the leading 
healing adjuncts to medicine. A knowledge of the 
value of hydrotherapy and balneotherapy is indispen- 
able to any physician ; this is especially true where a 
fully equipped office or a small sanitarium is conducted. 
A public bath establishment is a remunerative proposi- 
tion in any locality, with a population from two thous- 
and upwards, and will not only reimburse the physi- 
cian's income several hundred dollars a year, from the 
baths alone, but will be the means of having your bath 
patrons become acquainted with your other scientific 
therapeutic apparatus, and establishing your medical 
and surgical business. With this object in view your 
bath apartments should be open to the general public, 
other than invalids ; this can be certain days in the 
week, or certain hours of the day, as preferred, depend- 
ing upon the extent of patronage. Most physicians, 
who are conducting these establishments with limited 
space, have ladies call at certain hours or days, and 
gentlemen at other hours or days ; for instance, the 
ladies' days would be Monday, Wednesday and Friday, 
while the gentlemen's days would be Tuesday, Thurs- 
day and Saturday. On the other hand ladies can visit 
your institution in the forenoon, and the gentlemen in 
the afternoons and evenings. Of course this could be 
arranged to suit the demands of individual cases, etc. 

You will require the services of both a male and 
female attendant, and it is the physician's duty to in- 
struct these attendants in the technique of giving the 
different baths ; massage, alcohol nibbing, etc. 

Tt is advisable when establishing a bath institution 
to incorporate as many different forms of baths as pos- 
sible and establish a schedule of prices ranging from 25 
cents up. The following prices are those generally 
adopted at bath establishments : 

Plain tub bath, hot or cold, without attendant 25c 

Plain tub bath, hot or cold, with attendant, and al- 
cohol rub 50c 

Turkish bath, without attendant 50c 



HYDROTHERAPEUTICS, 51 

Turkish bath, with attendant, and alcohol rub 75c 

Russian bath, without attendant 50c 

Russian bath, with attendant, and alcohol rub.,.. 75c 
Super-heated air bath, (Betz bath), with alcohol 

rub $1.00 

Electric light bath $1.50 

Of course these prices could be changed to suit in- 
dividual requirements. 

The physician who has not given this phase of the 
subject special attention, may think it an exaggeration 
when I state that the patronage from baths alone will 
be the means of increasing his yearly income from one 
to two thousand dollars a year, even with limited equip- 
ments, and at the same time, will be the means of re- 
inforcing his professional business to fully this amount; 
of course your success will depend, somewhat, upon the 
amount of energy expended in making a bath institu- 
tion popular. Nearly all physicians, conducting bath 
establishments in connection with their practice, issue 
bath tickets, from which they make a small reduction 
where a course of baths is given. To illustrate the 
common, hot, or cold baths, with alcohol rub, which 
are listed at fifty cents for a single bath, a bath ticket 
is issued, giving a course of twelve baths for five dol- 
lars. Bath attendants usually expect to make a fair 
salary from the "tips" they receive, and they can con- 
duct the baths for you on either a salary or commission. 

Baths have been defined as the process of complete 
or partial immersion of the body, in some element or 
substance other than that to which it is normally accus- 
tomed; thus we may have hot or cold water baths, hot 
air, vapor, or medicated vapor baths, sand, mud or sun 
baths, electric, or electric light baths, etc. These baths 
may be given for pleasure and cleanliness, as surf bath- 
ing in the ocean, or for therapeutic purposes, for their 
effects upon elimination, stimulation, metabolism, etc. 
The temperature of baths varies, generally, from forty 
to four hundred degrees F., depending upon the sub- 



52 HYDROTHERAPEUTICS. 

i 

stance used and the. method of application. The fol- 
lowing temperatures is the standard in general use: 

Cold baths • . 45 to 65 degrees F. 

Cool baths 65 " 75 " F. 

Tepid baths 85 " 95 " F. 

Warm baths, . 95 " 10-0 " F. 

Hot baths..' . 100 "110 '' - F. 

Very hot baths 110 " 120 " F. 

Vapor baths 100 " 140 " F. 

Hot air baths 110 " 180 " F. 

Hot air blanket baths .... 200 "400 " F. 



BATH THERMOMETER. 

To determine the temperature of baths the physician 
should provide himself with a bath thermometer. This 
is a very important instrument, especially when you are 
keeping a record of bath patients. 

THE EFFECTS OF HOT, COLD, AND MEDI- 
CATED BATHS. 

It is the universal opinion that heat and cold, applied 
to the external surfaces of the body, will be conveyed 
to, or abstracted from, the deeper tissues; while this is 
true to a certain extent, the process of penetration, or 
depletion of heat or cold is very much overestimated. 
Various tests have been made by inserting a thermom- 
eter in the orifices of the body, the mouth, vagina and 
rectum, and the most accurate observers have noted 
only a fall of temperature in typhoid fever from two to 
four degrees, by the use of Brand baths and their mod- 
ifications, while a rise of temperature to an equal num- 
ber of degrees has been observed by the use of hot 
baths in cholera. One of the most important objects 
of hot and cold baths is the regulation of circulation, 
when we consider the fact that the skin is capable of 
retaining one-half of the blood in the body; and by im- 



HYDROTHERAPEUTICS. 53 

mersing the body in either superheated water, air or 
vapor will relieve blood pressure upon the internal or- 
gans. Every physician is familiar with this effect in 
convulsions of children and even adults. What is true 
in relieving the blood pressure in the cerebro-spinal 
axis, is also true with the portal system and other con- 
gested areas. 

Therefore, the physician should exercise much judg- 
ment in adjusting the temperature for a bath, for cer- 
tain people, and not aggravate any state of the system 
that cannot tolerate such an influence. The principal 
things to note are the conditions of the heart and blood 
vessels, in either too cold or too hot baths, bearing in 
mind that cold baths contract the capillaries to some 
little distance below the skin and drive the blood pres- 
sure inward, requiring forced cardiac pressure, while 
hot baths weaken the cardiac action by drawing the 
blood from the internal circulatory organs. 

From time immemorial, the laity have been taught 
that the only way to derive benefit from -'baths is to 
emigrate their anatomy to some fashionable mineral 
springs or bath resort, where the waters have an ob- 
noxious odor, or nature has provided water at an in- 
creased degree of temperature. This is illustrated by 
the patronage of the three principal bath resorts in 
this country. Mt. Clemens, Michigan, is noted the 
world over for its mineral baths, while the Hot Springs 
of Arkansas and Virginia are famous for their super- 
heated waters. One great advantage regarding these 
resorts is that nature has provided surrounding scenery, 
which is attractive to the invalid, and produces a degree 
of tranquility to the nervous system, which could not 
be obtained at home. 

The therapeutic value of the minerals contained in 
bath water is very much overestimated. This has been 
proven conclusively by many authenticated clinical 
tests. While there are many medicinal products which 
are capable of being absorbed by inunction, Dr. R. 
Winternitz has found it impossible to induce the direct 



54 HYDROTHERAPEUTICS. 

entrance of these substances into the skin from watery 
solutions. 

Dr. Rohrig experimented with iodine, and after re- 
maining in a strong iodine solution for three-quarters 
of an hour, failed to discover any iodine in the urine. 
Dr. Stas made similar experiments upon himself using 
sodium arsenate; although he occupied the full bath for 
prolonged periods no indication of absorption was ob- 
served. 

Strong mercurial full baths have also been experi- 
enced with the view of producing salivation, and only 
negative results have occurred, which, from a clinical 
point of view, have demonstrated the inertness of med- 
icinal substances in bath mediums. These unsettled 
facts of long cherished ideas, among medical men, that 
in order to receive the full benefit of baths, certain min- 
erals should be incorporated in the bath waters, are 
now regarded as pseudo therapeutic measures. 

If we were to compare the bath records from the 
mineral baths of Mt. Clemens, Mich., and Hot Springs, 
Ark., with the records from the Battle Creek, Mich., and 
other sanitariums, we would find the therapeutic value 
of hydrotherapy equal in every way to balneotherapy. 

The question naturally arises : then what advantage 
does the mineral bath have over the ordinary bath? 
First of all, it is more cleansing; this is especially so 
where the waters yield an alkaline reaction and an ele- 
vated temperature. They have a more stimulating 
action upon the sweat and sebaceous glands, and also 
allow a freer desquamation of old skin, and contact of 
the water with the body proper. There is a stimulat- 
ing effect upon the skin, produced by the chemicals, 
which aids materially in the eliminative process, while, 
also, saline or gaseous baths affect the circulatory and 
nervous systems in a reflex manner. The same is true 
with the hot or cold baths, and the greater the depar- 
ture from the normal temperature of the body, the 
greater will be the effects upon the reflexes through the 
central nervous system. Dr. Wood has pointed out, 
with much method, that heat and cold are conditions of 



HYDROTHERAPEUTICS. 55 

the same force, and depend upon the caloric intensity- 
above or below the normal temperature of the body. 

Modern chemistry has served the noble purpose of 
giving us the exact chemical constituents of nearly 
every mineral water in the country, and has also pro- 
vided us with a means whereby nearly all mineral baths 
can be procured in any locality, if so desired. In order 
that the reader may become familiar with the technique 
and therapeutic value of baths as used at these sani- 
tariums and watering places throughout the country, 
I will outline the methods of giving these baths as used 
in modern hydrotherapy, independent of the chemical 
constituents of the waters. 



BATH EQUIPMENT. 

There are two essential things required to conduct 
hydrotherapy in connection with a medical practice ; 
first, a good quality of water, and second, the proper 
apparatus with which to utilize the water. 

If you are living near a natural spring, or can obtain 
an artesian well in the locality of your sanitarium or 
office, so much the better, as water from this source is 
usually of good quality, and is held in greater esteem 
by the general public. For the purpose of elevating 
this water to a sufficient heighth to secure pressure 
throughout your offices, a hydraulic pump or wind- 
mill is often installed. Of course, where water is used 
from the city water-works this is not necessary. Your 
bath equipment can be as limited or extensive as you 
desire, but the maxim, "the best is none too good," is 
always the best policy to follow. I, therefore, refer the 
reader to the accompanying illustration, which outlines 
the arrangement and equipment of a modern bath apart- 
ment. These are stationary fixtures ; portable apparatus 
can be added to administer baths at the bedside of the 
sick, when desired ; or these elaborate fixtures may be 
duplicated by less expensive ones, with perhaps the 
same therapeutic results. This picture illustrates nearly 
every modern apparatus required to conduct hydrother- 



56 



HYDROTHERAPEUTICS. 



apy in a scientific manner, the details of which will be 
found in the following pages : 

The fixtures comprise the following: 1. Hydratic 
control table for regulating the force and temperature 
of the water. 2. Rose spray or needle bath. 3. Attach- 
ment for rain or shower bath. 4. Sheet blanket and 
towel warmer. 5. Sitz bath with wave spray 6. Tilt- 
ing basin with mixing valve and shampoo. 7. Perineal 
douch and stool. 8. Massage table. 9. Full bath tub. 
10 and 11, in the foreground are the electric light, Turk- 
ish and Russian bath cabinets. 




MODERN BATH EQUIPMENT. 



TEPID, WARM AND HOT BATHS. 



These baths are always found the most agreeable to 
patients, and the variations of temperature have been 
classified as follows : Tepid bath from 85 degrees F. to 
95 F. Warm baths from 95 degrees F. to 100 degrees 
F. Hot baths from 100 degrees F. to 110 degrees F. 



HYDROTHERAPEUTICS, 57 

In giving all baths we must take the normal tem- 
perature of the body as a standard, and any deviation 
from this temperature will have the depressive or stim- 
ulating reaction. 

Tepid and warm baths are generally employed for 
simple cleanliness, and as the heat balance is nearly 
equal, they are often referred to as natural baths, which 
are used after other bathing processes. 

Hot baths have a wide range of usefulness. They 
consume oxygen and have a marked influence upon 
metabolism. They eliminate carbon dioxide and in- 
crease oxidation. 

These baths are used to maintain the normal tem- 
perature of the body in depressive diseases, as cholera, 
and to relieve congestion and inflammation of internal 
organs by drawing the blood pressure to the surface. 

COOL AND COLD BATHS. 

One of the seeming paradoxes in hydrotherapy is 
that hot or cold baths produce nearly the same physi- 
ologic results, and if a pathological condition does not 
react to the hot bath, in many instances, it will to the 
cold, and vice-versa. The stimulating effect of the 
thermic irritants, when briefly applied, excites the per- 
ipheral sensory nerve terminals, and thus produces 
stimulation. Cold baths have always been used by ath- 
letes as a hardening process and are applied, in present 
therapeutics, as a process of reducing temperature in 
fevers. 

In the year 1861, Dr. Brand, of Stettin, wrote his 
first paper on cold baths as a process of reducing the 
temperature of fevers ; although his method of giving 
baths has many modifications, this process of bathing 
has always maintained the name of "Brand bath." The 
technique of giving this bath, as modified by Dr. James 
Tyson, and used in the treatment of typhoid fever, at 
the hospital of the University of Pennsylvania, is as 
follows: The folding or portable bath tub is placed 
by the bedside of the patient, containing water at a 
temperature of a'bout 70 degrees F. Compresses of ice 



58 HYDROTHERAPEUTICS. 

water, or the ice cap is applied to the head, which is 
allowed to rest upon an inflated rubber cushion during 
the bath. The patient is gently lifted into the water, 
and during the immersion, which lasts from ten to fif- 
teen minutes, the patient is constantly rubbed, to main- 
tain good circulation ; at the end of the bath, the pa- 
tient is lifted into bed, where he is rubbed dry, and 
placed between blankets. At the end of about fifteen 
minutes, the patient will cease to shiver; the tempera- 
ture is then taken, and the patient allowed to rest for 
three hours, when the temperature is again taken, and 
if it is found to exceed 102.2 degrees F., or above, the 
bath is repeated. If the temperature is found 102 de- 
grees F., or below, or over 101 degrees F., the bath is 
repeated in four hours from the last immersion ; if be- 
low 101 degrees F., or above 100 degrees F., repeat the 
bath in five hours. If below 100 degrees F., repeat the 
bath in six hours. If, at any time the temperature 
should reach 102.2 degrees F., the baths are repeated 
every three hours, and as many as six of eight baths 
may be given during twenty-four hours. As many as 
175 baths have been given during a course of treat- 
ment by Dr. Kinnicutt ; while the principal object of the 
bath is to reduce and control the temperature, other 
benefits are obtained of equal importance. The intel- 
lect becomes clear, and muscular twitching disappears, 
and there is a general tonic influence upon the nervous, 
circulatory, and respiratory systems, producing sleep 
and a general tranquility of the bodily functions. There 
are several counter indications for cold baths. They 
should not be employed with too young, or aged pa- 
tients, with weak vitality. After the cold bath, there is 
always a reaction ; the skin, which was shrunken and 
pale from the cold, in ten or fifteen minutes takes on a 
glow of red and warmth, showing that the blood has 
again occupied the capillaries of the integument. This 
is the most important feature of the bath ; it is through 
this reaction that all baths derive their greatest thera- 
peutic value, and where patients fail to receive this 
reaction, cold baths should be duplicated with tepid or 



HYDROTHERAPEUTICS. 



59 



warm baths to develop the reaction power. Careful 
statistics have been recorded, at different hospitals in 
this country, relative to the value of baths in typhoid 
fever. Dr. Gilman Thompson states that the mortality 
from this disease has been reduced from 16 to 6 per 
cent in New York hospitals, since the introduction of 
the Brand bath. Dr. H. P. Loomis reports a reduction 
of 50 per cent since the introduction of this bath, and, 
comparing the number of deaths in former years, it is 
estimated that fully one thousand lives have been saved 




1. ALassa.se isj.e Shower and Netdle Bath; 

2. Superheated Air Bath Apparatus. 

3. Electric Light Bath Cabinet and Douch Room. 

4. Rest and Massage Room. 



each year in New York city alone from the use of these 
baths. There are many other substitutes for the Brand 
bath, principal of which are the graduated bath, cold 
pack and ice rubbing. The graduated bath is obtained 
by placing the patient in a tub of water, at about the 
normal temperature of - the body, which is gradually 
cooled, until it reaches 80 or 90 degrees F., constantly 



«0 HYDROTHERAPEUTICS. 

rubbing the patient during the bath; while this bath is 
not as stimulating as the cold bath ; it is a good sub- 
stitute. 

The cold or cooling wet pack is another good sub- 
stitute for the Brand bath, and has the advantage that 
it can be applied in localities remote from bathing 
-equipments. The bed is covered with oil cloth, and 




PORTABLE BATH CABINET. 

the patient is wrapped in a sheet saturated with water 
at 70 degrees F., as the sheet warms, a new one is to 
be applied until, during the course of ten or fifteen 
minutes, five or six applications have been made ; in 
preference to changing the sheets the crescent bath 
douch, or the gardener's sprinkling can is used, to keep 
the surface cold. 

The ice rub, or ice ironing, .and ice poultices are 
also often substituted for the Brand bath. The ice rub 
is produced by a flat piece of ice, wrapped in gauze, 
with which the body and limbs are thoroughly rubbed. 
The ice poultice is made by mixing finely pounded 
pieces of ice with either bran, corn meal or sawdust. 
These may be used either by immersing the entire body, 
or applied locally, as poultices. 



HYDROTHERAPEUTICS. 



6 J 



THE TURKISH BATH. 

For the universal use of the Turkish, or superheated 
air bath, we are, perhaps, indebted to David Urquhart, 
an English representative at the Court of Constanti- 
nople some sixty years ago. Mr. Urquhart had a sun- 
stroke while living in that city, and his recovery was 
credited to the use of the superheated air baths, which 
for many years have been in vogue among the people 




STATIONARY BATH CABINET. 



of Turkey. On his return to England, he expounded 1 
the therapeutic value of these treatments for different 
diseases, with the results that they were promptly 
adopted in many cities in Europe and America, and to- 
day no hospital or sanitarium is considered completely 
equipped without this valuable curative agent. Its 
effects are refreshing, cleansing and decidedly stimulat- 
ing to the circulation, and it is one of our very best 
means of eliminating toxic influences from our bodies. 

The principal object of this bath is to produce pro- 
fuse perspiration. The original Turkish bath consisted 
of placing the naked body in a room with dry hot air, 
at a temperature of 110 degrees F. to 130 degrees F.,. 



62 HYDROTHERAPEUTICS. 

where he is allowed to remain for ten to fifteen min- 
utes, until free perspiration is established. He then 
enters another room with still higher temperature, from 
150 degrees F. to 200 degrees F., for a few minutes until 
the diaphoretic action is very profuse; he is then placed 
upon a marble slab, and given a thorough rubbing with 
the bare hands. This is followed with a soap shampoo 
with a loofah or Egyptian sponge. Of late years there 
have been many improvements in the technique of giv- 
ing these baths, and various bath cabinets have been in- 
vented, which produce the same therapeutic results, 
and are more agreeable to the patient. All these cab- 
inets are arranged so the head may protrude, thus allow- 
ing the patient to breathe pure, fresh air, instead of the 
oppressive atmosphere of the Turkish bath room. The 
technique of. giving these Turkish cabinet baths is as 
follows: The patient is supplied with a clean sheet, 
with which to wrap his body, and placed in either a 
wood or oil cloth cabinet or bath chair (see cut) which 
can be heated from either a steam or hot air furnace, 
or an alcohol heater. After adjusting the cabinet about 
the patient, a towel should be wrapped around the pa- 
tient's neck to retain the heat in the cabinet, and a 
cold cloth applied about the head ; allow the patient to 
drink all the water he may desire, which assists in pro^, 
ducing the diaphoretic results, and the eliminative 
effects of the bath. After the patient has remained in 
the cabinet from fifteen to thirty, or more minutes, he 
is then placed in the warm full bath, and thoroughly 
rubbed for a few minutes during this bath ; he is now 
wrapped in a blanket, and retires to the rest room, 
where the perspiration will continue for about a half 
hour or hour. During this time the patient will feel 
inclined to sleep, and the body will resume its normal 
condition ; then the patient is allowed to take a final 
shower bath, with a soap shampoo, and rub his skin 
dry with a rough towel, and dress. The foregoing is 
the general procedure of the Turkish bath, as given at 
the present time, at most bathing institutions, and is 
one of the most important procedures in hydrotherapy. 



HYDROTHERAPEUTICS. 63 

This bath has been largely succeeded, however, by the 
electric light bath, given in the foregoing chapter; the 
technique of the bath is just the same in both baths, 
only electric lights are used to produce the heat. This 
method is much more effective, and also combines the 
therapeutic influence of light. 

THE RUSSIAN BATH. 

This bath is also adopted for its diaphoretic influ- 
ence, and is conducted the same as the Turkish bath, 
only using steam instead of hot air for heating the cab- 
inet. The temperature of this bath is considerable 
lower than the Turkish bath, as the steam renders the 
higher temperature unbearable. The bather remains in 
this cabinet ten or twenty minutes, and the same pro- 
cedure, and after-treatment is carried out as with the 
Turkish bath. 

HOT AIR BLANKET BATH. 

This bath is also called the superheated air bath, 
and often referred as to the Betz bath, inasmuch as this 
gentleman has devised extensive apparatus for conduct- 
ing the bath. This bath is really a combination of the 
Turkish and Russian baths. The superheated air is 
supplied by artificial means and the steam from the 
body of the bather. To conduct this bath the patient 
is wrapped in several thicknesses of blankets, and then 
placed in an "oven," where the temperature is from 200 
degrees P., to 400 degrees F., and allowed to remain 
from twenty minutes to one-half hour, or longer, until 
free perspiration is established. He is then removed to 
the rest room, and allowed to steam for ten or twenty 
minutes, when the steaming blankets are removed, and 
the body wrapped in dry blankets ; after a rest of about 
one hour, the same after treatment ^s conducted as in 
the foregoing baths. This is one of the most effectual 
baths in hydrotherapy, and is especially adopted in the 
treatment of inflammatory rheumatism ; when the pa- 
tient is helpless. These baths can also be conducted to 



64 HYDROTHERAPEUTICS. 

local parts, by the use of special cabinets, in the treat- 
ment of inflamed joints to obtund pain, etc. 

A WORD OF CAUTION. 

Before adopting any of the superheated baths, the 
patient should be thoroughly examined to ascertain the 
condition of his heart, and during the bath, the patient 
should be allowed all the cold water he desires. This 
increases the diaphoretic effects of the bath. The head 
should also be kept cool by the application of cold 
cloths, and the opening through which the head pro- 
trudes in the cabinet should also be tightly closed, by 




wrapping cloths around the neck to prevent the escape 
of heat or steam. 

The question often arises: which cabinet will be the 
best to install for an office or small sanitarium? My 
answer would be: the electric light cabinet, by all 
means, as it is the safest, cleanest and quickest in ac- 
tion of all bath cabinets, and avoids the danger of acci- 
dents from breaking pipes, etc. There are also well 



HYDROTHERAPEUTICS. • 6& 

founded conclusions that the physical properties of the 
two agents, light and heat far excel any other process 
in producing the diaphoretic effects desired, and the 
penetrating power of the two agents, which are so 
closely related in physical properties to sunlight, pene- 
trate the deeper structures and stimulate the metabolic 
processes and bodily activities. 

Where another cabinet is added, a combination of 
heated air or steam is best for all medicated vapor 
baths, etc. 

The Turkish, Russian, Electric light, and the Super- 
heated air Blanket bath are among the most indis- 
pensable of bath equipments, in the treatment of many 
diseases. Their principal therapeutic effect is elimina- 
tion through the cutaneous surface; they are, therefore, 
used in the treatment of alcohol and the drug habits, 
kidney diseases, rheumatism, joint and kindred affec- 
tions, where the rapid elimination of toxic influence is 
desired. 

ALCOHOL, SALT AND ICE RUB. 

The above substances are largely used at bathing 
institutes, as an adjacent to hydrotherapy. Alcohol is 
usually employed as a finishing means. Only pure, 
grain alcohol should be used, either slightly diluted or 
pure. From two to four ounces will be sufficient for 
each bath. This is poured into the hand and applied 
to the different sections of the skin, until the entire 
body has been thoroughly covered. This method adds 
tone to the skin, improves circulation, and prevents the 
patient from taking cold after bathing. 

MEDICATED, VAPOR, AND TUB BATHS.. 

Medicated vapor baths may be taken in the cabinet,- 
by the use of the vapor pan, a special apparatus to 
supply the medicated vapor, which is placed under the 
bath stool. The medicated solution is placed in the 
pan, and the heat underneath produces the vapor; by 



66 HYDROTHERAPEUTICS. 

medicating any solution, the fumes given off in the 
steam will produce its medical influence upon the body. 

SULPHUR BATHS. 

May be obtained by either vapor or in the tub by 
the following solution, which is known by several 
names: Sulpholine, liquid sulphur, Sulphol, etc. 

Lime 1 oz. 

Sulphur 2 oz. 

Water 1 qt. 

Boil in an enamel or porcelain vessel until dissolved, 
and add from two to four or more ounces, to thirty 




VAPOR PAN AND HEATER. 

gallons of bath water for a tub bath, or dilute and use 
in vapor bath pan. This bath is highly esteemed by 
many in the treatment of several skin diseases. 

Another preparation used in sulphur baths is as 
follows : 

Precipitated sulphur 2 oz. 



HYDROTHERAPEUTICS. 67 

Sodium hyposulphite 1 oz. 

Dilute sulphuric acid Yi oz. 

Water 1 pt. 

The above can be used to 30 gallons of bath water, 
or used as a vapor in cabinet baths. 

Many bath establishments prefer to give sulphur 
baths with some one of the sulphides, the sulphide of 
sodium being preferable, owing to its solubility in 
water; this gives all the characteristic obnoxious aroma 
found around sulphur springs, and is used when they 
wish to imitate these fashionable resorts. 

PINE NEEDLE BATH. 

One ounce of Oleum pini sylvestris, (pine needle 
oil), is placed in the vapor pan, with several ounces of 
water, and the patient is .steamed for thirty minutes 
in the bath cabinet. The after treatment is the same 
as in other vapor baths; this is also useful in the treat- 
ment of many skin diseases. Acid, alkaline and other 
baths may also be given in the same way, but the two 
mentioned above are by far the most useful. 

MUD, LAVA, FANGO, PEAT AND SAND BATHS. 

(Antiphlogistic Baths.) 

These baths are very highly esteemed in many parts 
of Europe, and have become quite popular in this coun- 
try, at a little health resort in Northwestern Indiana, 
(Kramer, Ind.), where has been coined the names of 
Mudlava, Moor-Baths, etc. In the volcanic district of 
Italy the lava is used for this purpose under the name 
of Fango baths; the color of this substance is a grayish 
brown, and about the consistency of butter. The 
Fango is applied about the body, at a temperature 
approximating 110 degrees F., and a gentle massage 
of the body is given during, and after the pack or bath, 
which lasts about one-half hour. 

In several places in this country a good quality of 
blue clay, which has been thoroughly ground, is sub- 



68 HYDROTHERAPEUTICS. 

stituted for Fango, with nearly equal therapeutic results. 
These baths are especially beneficial in the treatment 
of stiff and painful joints, arthritis, sub acute rheuma- 
tism, sprains, neuritis and all injuries of the ankle, etc. 



mm 



:» \\, 



mmm 



'*&*/.■ 



MUELAVA BATHS. 



SITZ OR HIP BATHS. 

These baths are generally given in a tub, designed 
for the purpose (see bath equipment illustration), and 
may be either hot or cold, according to the effect de- 
sired. During the bath the rest of the body should 
be wrapped in blankets, and the feet also placed in a 
pail of warm water. Sitz baths are given for their 
local effect in the treatment of diseases of the abdom- 
inal and pelvic organs. Hot baths divert blood from 
these organs, and cold baths congest them. The hot 
Sitz bath has always been an important treatment in 
many menstrual disorders ; amenorrhoea, dysmenor- 
rhoea, neuralgia, and pain within the pelvic and abdom- 
inal cavities. Cold baths are given for their tonic 
effects, in the treatment of paralysis and intestinal 
atony, impotency and sexual debility of the male ; also, 
hemorrhagic states of the bladder, intestines and uterus, 
hemorrhoids, etc. 




HYDR0THERAPEUT1CS. 69 

SHOWER AND NEEDLE BATHS. 

The shower or rain bath was first adopted by the 
Germans, and is one of the most convenient and 
cleansing of bathing methods. It has many advantages 
over the tub bath, inasmuch as it requires only about 
one-tenth the amount of water, and the time required 
for bathing is much less. There is also economy in 
space for apparatus ,and avoids the danger of com- 
municating diseases in public places. 

Shower baths are given with a view of imitating 
rain by a special device which hangs above the head. 
The spray can be regulated in force or temperature as 
desired. This bath has of late years been given in con- 
nection with the needle bath or douch, which consists 
of another device enveloping the body on the sides, 
whereby minute streams of water are thrown upon the 
body from all sides, giving the body a sensation as 
though needles were pricking it. The sharp stimulus 
these small streams produce upon the skin is very 
invigorating. The needle and shower bath can be 
operated independently, or hot and cold showers may 
be given as desired. A very stimulating effect is pro- 
duced by alternating the hot and cold sprays; these, 
two bath processes are, generally, used as an after bath, 
or as a cleansing process, following the Electric light, 
Turkish and other cabinet baths, 'being the simplest 
and best way to tone the skin before leaving bathing 
establishments. The patient will withstand the prevail- 
ing temperature without taking cold. 

THE HOT AND COLD DOUCHES. 

These douches consist of a single stream of water, 
coming from a nozzle of a % or y 2 inch in diameter, 
at a distance of 8 to 10 feet from the patient, and may 
be regulated from intense cold to warm, as the treat- 
ment demands. 

Dr. Charcot was among the first to adopt this hydro- 



70 



H VDROTHERAPEUTICS. 




THE SHOWER BATH. 



HYDROTHERAPEUTICS; 71 

therapeutic measure, and treated many cases of hysteria 
with marked benefit, by applying a cold douch to the 
spine, at a temperature from 40 degrees to 60 degrees F. 

Cold douches are also used in chronic constipation 
and general auto-intoxication, insomnia, anaemia and 
other conditions, for their tonic and reactive influences. 
Hot and cold douches are also used, known as the 
Scotch douch. This douch is produced by two streams 




CRESCENT BATH DOUCH. 

of water, one hot and the other cold, varying in tem- 
perature from 55 degrees F. to 110 degrees F. These 
douches are applied to the spine and posterior thorax 
and sides; also to the abdomen and lower extremities, 
but not to the anterior chest. The alternating of hot 
and cold is very invigorating, and the tonic effects are 
used in many forms of paralysis and low forms of 
vitality. 

, GALVANIC AND FARADIC TUB BATHS. 

These baths are given for their stimulating effect 
upon the body, and can be utilized for any purpose 
where these electric currents are indicated in general, 
and is a most excellent means for supplying the current 
to the entire body by placing one electrode at the head 
of the bath tub and the other at the foot or to stimu- 
late the primea viae. The patient may sit in the center 
of the tub with the water up to or above the waist line 



72 



HYDR0THERAPEUT1CS. 





ELECTRIC TUB BATH APPARATUS 



HYDROTHERAPEUTICS. 73 

and the electrode placed upon each side of the tub, and 
any style of portable battery may be used or a special 
apparatus devised as is illustrated in the accompanying 
diagram. 



l &' 



SALT RUB OR GLOW. 

The salt rub or glow, as it is frequently called, is 
another means of producing a tonic effect to the skin, 
and is a substitute for sea bathing. This procedure is 
conducted in a tub of salt water, at a temperature of 
104 degrees F. Five pounds of salt to forty gallons 
of water is the bath solution During the bath the 
patient is constantly rubbed by the attendant, taking 
a small handful of salt and rubbing different parts of 
the body vigorously. After the body has been thor- 
oughly covered by this process, the patient is generally 
given a final shower bath and rest. 

The Ice rub, or ironing, is also used to produce 
reaction of the skin and other organs. Tt is used 
largely in sunstroke. A flat piece of ice or a sack filled 
with ice is rubbed over the body of its reflex influence. 

In conclusion, will say that Hydrotherapy is fast 
winning the confidence of the medical profession as a 
remedy, and water, like many other things provided in 
nature, is one of the natural means of restoring health. 
Dr. Winternitz, of Vienna, and Dr. Baruch, of New 
York, have been striving for years to make hydro- 
therapy the common property of the Medical Profes- 
sion, " and to this end have endeavored to extol its 
virtues as it justly merits and avert the empirics who 
are springing up in every direction as water-cure doc- 
tors. This is one of the adjuncts of medicine, which 
belongs to the physician and by adopting Hydrotherapy 
in connection with an office or Sanitarium practice, 
your efforts will be dou'bly rewarded, by the success 
you will obtain. 



74 OSTEOPATHY. 



Swedish Massage and 
Osteopathy 



The evolution of massage as practiced in Sweden, at 
the present day, has a long chain of ancestry. The 
Chinese were known to use certain manipulations three 
thousand years before the Christian era. The ancient 
Egyptians and Hindoo priests acquired a knowledge of 
manipulation, which was supposed to be invented by 
the Gods; the Persians used several forms of manipula- 
tions for different affections, which were followed in 
practice by the Greeks and Romans. 

In the sixteenth century an effort was made to com- 
bine massage and movements of the body with medi- 
cine for the treatment of disease. 

At an early period in the nineteenth century, P. H. 
Ling, of Sweden, founded the first scientific system of 
massage, and body movements. His work was suc- 
ceeded by Dr. Mezgar and arranged into a system, 
which is now extensively used, not only in Sweden but 
throughout the entire world. According to Dr. Mez- 
gar's teachings, the scientific application of massage is 
based upon a thorough knowledge of the anatomy and 
physiology of the body, and each movement or manip- 
ulation is conducted for the specific purpose of produc- 
ing a normal equilibrium of the functions of the body. 
All manipulations are passive, and applied to the nude 
skin, without the patient's assistance or resistance, and 
arranged systematically, so as to act upon the different 
tissues and organs of the body. 

Dr. Mezgar has divided the massage treatment into 
four principal manipulations namely: efffeurage, fric- 
tions, petrissage and tapotement. 



MASSAGE. 75 

EMeurage consists of stroking a given part towards 
the body or heart; this may be accomplished by using 
the fingers and thumb, or the palms of one or both 
hands, or by the thumb or fingers separately. 

Frictions are firm, circular, deep-seated movements, 
applied with the thumb or tips of the fingers, towards 
the body or heart, generally over a certain group of 
muscles at a time. 

Petrissage, or the kneading of muscles or organs is 
accomplished with two thumbs, or the thumbs and fin- 
gers of both hands for the purpose of raising or loosen- 
ing the muscles from their attachment, in the treatment 
of rheumatism or stiffened muscles, etc. This is also 
conducted by rolling the muscles on the bone, and clap- 
ping the muscles to revive new activity. 

Tapotement is the tapping or percussing either with 
the tips of the fingers, where light pressure is desired, 
as on the surface of the face, or hacking with the ulnar 
border of the hands; this is used around nerve centers, 
and upon muscles where heavier pressure is desired. 
Beating is also practiced with the closed fist over deep 
muscles and large nerve trunks, as the sciatic. 

What constitutes an efficiency of massage is to be 
determined by the force and frequency of the manipu- 
lations, and the length of time during which they are 
employed. A good manipulator will accomplish more 
in fifteen minutes than a poor one will in one hour, and 
it is an art which requires much experience to handle 
successfully. The directions of most of the Swedish 
massage movements are the same as vibratory massage, 
from the extremities to the trunk, from the insertion of 
a muscle to its origin, and in the direction of the re- 
turning currents of the blood, and lympathic system. 
With this object in view, special attention should be 
given to the inside surfaces of the extremities in the 
axillae and groin, to unload the lymphatics and expel 
diseased particles and effete matter. 

While Swedish massage will always hold a respected 
position in the manual treatment of disease, physicians 



76 OSTEOPATHY. 

of the Occident, as a rule, are, apparently, too indolent 
to put the system into active practice to any great ex- 
tent, and until vibratory massage was introduced, in 
which the technique is very closely allied, massage was 
very little used in this country ; the technique of the 
different manipulations, as they have been substituted 
by vibratory massage will be discussed in the succeed- 
ing chapter. 

Osteopathy was founded by Dr. Andrew Taylor 
Still, a regular practitioner of medicine and army sur- 
geon, who, nearly half a century ago, conceived the idea 
that medicine did not incorporate all the benefits of the 
healing art ; that the body is an organic machine, and 
may become impaired or its parts misplaced, which re- 
quire adjusting, the same as any other piece of mechan- 
ism. After silently carrying on his experimental work 
in this field, he was finally crowned with success. In 
the year 1887 he began to teach his sons this new art 
of healing, and later established the American School 
of Osteopathy, which is turning out graduates broad- 
cast ; working side by side with physicians, and con- 
tributing their share of success in relieving the sick and 
suffering. Osteopathy, like nearly every other new 
branch of healing art, was very much criticized and 
ridiculed in its infancy, but physicians and the laity 
have been compelled to accept the truth, and today 
osteopathy has passed its experimental stages and holds 
a respected position as one of the noblest causes which 
man is called upon to officiate — restoring health. 

Osteopathy is like Swedish massage, inasmuch as it 
is purely a manual treatment for disease ; it is also 
analogous to vibratory massage, as the technique of the 
treatment often has a striking resemblance. The only 
difference, in many of the manipulations, is that nature 
gave the osteopath his instruments to work with — his 
fingers and arms — while mechanical genius has supplied 
us with the various forms of vibrators. It will, there- 
fore, be seen that osteopathy has a great advantage over 
vibratory massage in emergency cases, as the operator 



MASSAGE. 77 

always has his instruments with him, and can always 
treat his patients, either at the bedside or in emergen- 
cies, without the delay of time in securing a vibrator, 
and oftentimes, the operator cannot be supplied with 
the motive power, in places where he wishes to treat 
his patient. This is particularly so in the country, 
where he does not have access to the electric currents. 
We, therefore, find that while vibratory massage can 
be used to excellent advantage in office practice, osteo- 
pathy can be applied on all occasions, and at all places. 
To illustrate: the writer was once making a social call 
on an old patient, and found the daughter suffering in- 
tensely with dysmenorrhea. Under ordinary circum- 
stances, if I had my medicine case with me, I would 
have given an analgesic, or might, in this case, have 
depended upon a hypodermic of morphine ; but my only 
alternative was osteopathic manipulations. I therefore 
applied sufficient pressure to inhibit the nerve centers 
of the lumbar region, especially the tender areas of the 
third, fourth and fifth lumbar centers. I also gave the 
entire spinal column a general treatment; in less than 
five minutes the pain had entirely disappeared, and the 
patient enjoyed a very restful night. This is only one 
case in hundreds where a knowledge of osteopathy can 
render the physician better service than drugs, and if 
the practitioner will acquire a knowledge of osteopathy 
to the extent of relieving pain alone, his time would 
be well spent. 

To understand many of the fundamental principles 
of osteopathy, which are so analogous, in many ways, 
to the technique given in vibratory massage, the reader 
is referred to the accompanying chapter for the local 
areas and land marks, which are incorporated largely 
by osteopathic manipulations. 

Osteopathy, Swedish and vibratory massage, and all 
drugless methods of treatment, are directed in the same 
course ; to stimulate or inhibit through reflex action, the 
centers controlling the functions and organs of the 
body, thus assisting nature in dispelling disease, and to 
obtain and maintain a healthy equilibrium. 



78 OSTEOPATHY. 

Dr. Goetz mantains: that when all obstructions to 
the natural direction of life forming and healing ener- 
gies that are resident within the body are removed, and 
all chemical changes preparatory to nutrition are cor- 
rected, as they may be without medicine, then nature 
swiftly and surely regains her normal equilibrium of 
health and strength. It will, therefore, be seen that 
Swedish massage and osteopathy have many things in 
common with the technique of vibratory massage ; the 
only difference being the mode of application, the for- 
mer being applied by the hands and the latter with an 
instrument or vibrator. It would be only a repetition 
to discuss the technique of each, separately. This is 
particularly so with many of the treatments of the 
spinal column. We may obtund pain in certain local- 
ities by desensitizing the nerve force, either by direct 
pressure or manipulation with the cushioned ends of 
the fingers or by the "Tapotement" of massage, or the 
machanical vibrator; the effect will be the same. 

Of course there are several features favoring osteo- 
pathy, in the treatment of many diseases, which osteo- 
pathy will reach, where vibratory massage cannot be 
utilized. This is particularly so in luxations of the 
bones and muscles, ligaments, etc., and their inping- 
ment of nerves. 

Most of the diseases of the body are reached 
through the nerves of the spinal column. These nerves 
control motion, sensation, nutrition, and other' func- 
tions of the body; therefore, manipulation of the spinal 
nerves bears the same relation to the osteopath and 
vibratory therapeutist as the keyboard of a piano does 
to a pianist, the mechanism proper is on the inside of 
the piano, but is controlled from the keyboard. Like- 
wise, many diseases of the body can be controlled from 
the spinal nerve centers by manipulating with the 
cushioned tips of the fingers or a vibrator, and inas- 
much as Swedish massage, osteopath and vibratory 
massage are so closely related, we will discuss the tech- 
nique more thoroughly in the succeeding chapters. 



VIBROTHERAPY. 79 



Vibrotherapy 



Physicians, as a rule, never take very kindly to the 
manual methods of massage, which are outlined in the 
foregoing chapters. One .possible reason may be that 
it involves too much labor, but when some mechanical 
genius invented the Vibrator about twelve years ago, 
it was immediately recognized by the medical profes- 
sion, and received as hearty welcome from the 
physicians as the sulky plow did from the farmer: "It's 
the easy way." 

One of the most important things to be considered 
in adopting Vibratory therapeutics in office practice is 
the selection of a vibrator. There are many types, with 
varying degrees of efficiency. Therefore, in selecting a 
vibrator the following points should be considered: 
The instrument should have sufficient motive power to 
deliver long, penetrating strokes, as well as medium 
and light ones, in order to receive the degree of stimu- 
lation or inhibition desired ; it should also be capable 
of changing from a heavy to a light stroke, and vice 
versa, without any delay. It should have a well local- 
ized stroke and also a rotary and lateral stroke, for 
treating cavities. 

A well constructed vibrator should never give any 
vibration to the operator's hand ; by observing these 
points we really have a scientific instrument with which 
excellent results can be obtained. 

Physicians have long recognized the value of stimu- 
lation, and for many years have depended upon elec- 
tricity and Swedish massage for this purpose. We 
must give Dr. Still credit, however, for revolutionizing 
the older methods of massage and placing the subject 
purely upon a scientific basis, by complying with the 
anatomical structures of the body and physiological 



so 



VIBROTHERAPY 




THE SHELTOX VIBRATOR. 



A— Switch to turn electric current on or off. B— Lever to regulate the length 
of the stroke. C— Sliding sleeve that holds applicator shaft. D— Separate from 
E to avoid twisting of cord. E— To be connected with D. D and E form what 
is called a separable plug. F — Oil holes. Oil once or twice a week for or- 
dinary use. 



VIBROTHERAPY. 



81 



laws of nature. Vibratory massage is, therefore,^ a 
means of conducting many Osteopathic and Swedish 
massage treatments by a more convenient and less 
laborious method; the regional technique and vaso 
motor areas are the same, and the only distinction is 
the manner of conducting the same influence by dif- 
ferent means. 

The most important field of operation of both 
Osteopathy and Vibratory massage is located between 
the transverse processes of the spinal vertebrae. At 




At left distribution of spinal nerves in sacrum and coccyx. 

At right (1 and 2) rami communicanties 3, 4, 5, and 6 spinal ganglia. 

these points we find the main nerve trunks, conveying 
and imparting impressions to and from the brain, 
recognizing two great systems of nerve force in the 
body ; the cerebro-spinal nervous system controlling 
sensations and motion, and the sympathetic nervous 
system, superintending the functions of the internal 
organs, which govern secretions, excretions, circulation, 
digestion, etc. 

Many of the internal organs receive nerves from 
both systems; by referring to our anatomy we will find 
a double chain of ganglia of the sympathetic nerves on 
the anterior surface of the spinal column, extending 



82 VIBROTHERAPY. 

from the base of the skull to the end of the coccyx. 
These ganglia have communicating branches, which 
connect with the cerebro-spinal nervous system, called 
rami communicanties. We, therefore, find that treating 
the nerve centers of the spinal column, as they emerge 
through the brain and spinal cord, has the power of 
conveying impulses to and from the periphery. These 
are called efferent and afferent nerves; the former con- 
vey impulses from the brain to the various peripheral 
organs; these nerves control muscular activity and 
conduct impulses to the glands and excite secretions. 
They also control the vaso-motor impulses to the walls 
of the blood vessels, which regulate the caliber of the 
blood vessels and circulation of the blood, and also 
conduct impulses which will stimulate or inhibit the 
activity of any organ. 

The afferent nerves carry the impulses from the 
peripheral organs to the brain ; thus we find the special 
sense nerves of the eye, ear, nose, mouth and skin, 
which give rise in the brain to conscious sensations. 

We also find special reflex nerves which conduct 
impulses to the nerve centers, to be reflected out 
through the efferent nerves to muscles, glands, blood 
vessels, etc. 

In treating diseases by vibratory means we have 
three degrees of therapeutic application, depending upon 
the length of the stroke and the amount of pressure 
used. 



DEGREES OF VIBRATION. 

Stimulation is produced by a short stroke and 
light pressure. 

Sedation is produced by a medium stroke and pres- 
sure, used as a sedative to quiet excitability and promote 
sleep. 

Inhibition is produced by a long stroke and heavy 
pressure. This is used to desensitize nerve centers, and 
will mitigate pain, slow the action of the heart, check 



VIBROTHERAPY. b. 

peristaltis, stop hiccough, etc. Always bear in mind 
that all deep nerve trunks or centers, as a rule, require 
a long stroke and heavy pressure ; while the super- 
ficial nerves require only the short strokes and more 
gentle pressure. In order to obtain the different de- 
grees of strokes and pressure, the operator should see 
that the vibrator is supplied with a variety of vibratodes 
or applicators, which can easily be attached to the 
vibrator, for treating the different areas and cavities 
of the body. The accompanying cuts illustrate the 
modern portable vibrator, with all the applicators re- 
quired for general use. 

The selection of a vibratode for a given area, will 
depend upon the results you expect to obtain ; the 
following is the general rule : A., represents the hard 
rubber ball applicator, which is used in treating intra- 
spineous spaces when stimulation or inhibition is de- 
sired. B., is a soft rubber applicator often referred to 
as the "brush"; this is used over sensitive areas, as the 
face, abdomen, etc., where sedation or inhibition is 
desired. C, is a soft rubber cup applicator; this is 
used over surfaces of the body for its sedative effect. 
D., is also used for the same purpose as C. E., is a 
soft rubber applicator for the eye and ear. F., is a 
soft rubber vaginal applicator. G., a hard rubber rectal 
applicator. H., hard rubber external rectal applicator. 
I., solid soft rubber ball, used same as "A" over sensi- 
tive areas. J., large disc for treating the surfaces of 
the body. K., is a soft rubber attachment for giving 
an intermediate stroke with other applicators. L., soft 
rubber rectal or vaginal applicator. M., hard rubber 
prostatic applicator. O., is a soft rubber intestinal 
applicator. P., hard rubber cone rectal applicator. Q 
hard rubber oval disc applicator. R., hard rubber half- 
ball applicator. S., soft rubber cup applicator. T., soft 
rubber disc applicator. U., soft rubber vacuum half 
ball applicator. W., large two and one-half inch sof* 
rubber cup applicator. 



84 



VIBROTHERAPY 




in 



• 










] 



^ 



VIBROTHERAPY. 



85 




86 VIBROTHERAPY. 

PHYSIOLOGICAL BASIS. 

» 

The fundamental principles upon which vibratory 
massage are based, may be compared somewhat to 
electricity, although the current waves from electricity 




POSITION FOR TREATING THE BACK. 

are more rapid in their stimulating effect upon meta- 
bolism. 

Vibratory massage may be used at a slower and 
stronger rate without being as disagreeable to the 
patient. In many instances most pathological condi- 
tions are due to stasis, and by stimulating the nerves 
which control the circulation of the part, and by open- 
ing up the lymphatic drainage system, to carry away 
waste material, we have accomplished by vibratory 
massage what cannot be accomplished by any other 
means. As a rule, vibration is best applied as near a 
nerve center as possible, and by treating the cerebro- 
spinal nerves as they emerge from the spinal column, 
better results will be obtained in less than half the 
time it would take, if we treated the nerves farther out 
on their course. Nerve centers seem to have a certain 
amount of intelligence, enough at least, to adjust any 
abnormal condition within the reach of their jurisdic- 



VIBROTHERAPY. 81 

tion. We, therefore, find that vibratory massage has 
its therapeutic effects in both a direct and indirect way; 
to illustrate: if we were to treat an inflamed joint, we 
would recognize that we have a condition of stasis to 
deal with, and to relieve the congestion or inflamma- 
tion, our only means would be to treat the lymphatics, 
that drainage may take place from the joint, and open 
the avenues of elimination ; at the same time, our at- 
tention would be called to stimulating the nerve cen- 
ters, which would produce new nourishment to the 
part. The joint proper may not be treated at all. 

GENERAL AND REGIONAL TECHNIQUE. 

Patients who are to be treated by vibratory massage 
should wear as little clothing as possible, over areas 
treated. If the patient is a lady she should remove her 
corset and other outer clothing down to the under vest. 
A light kimona may be worn, if desired, but the less 
clothing worn by either man or woman the better. In 
treating the spinal centers, the patient should be placed 
upon the table, face downward, and it is often a good 
plan to place a large pillow under the abdomen ; this 
convexes the spinal rolumn and allows better access to 
the spinal nerves. 

The hard rubber applicator should be used in treat- 
ing the spinal centers, and when the degree of the 
desired stroke is decided upon, the applicator should be 
pressed well in the sides of the inter-spinons openings 
of the transverse vertebras, on both sides of the spinal 
column. 

Dr. Head was among the first to point out the vaso- 
motor centers and pain areas of the spinal column, 
which are illustrated in the accompanying diagram. 
Although this cut may have the appearanue of a Chi- 
nese puzzle, it represents, and outlines the vaso motor 
centers on the left side, and the visceral afferent floors 
of the spinal ganglia, or the pain areas, which call for 
treatment on the right side. To illustrate: If we wish 
to treat the stomach, the apex of the triangle points to 



B8 VIBROTHERAPY. 

the word "stomach," on both sides of the spinal column, 
the left side, the base of the triangle is from the second 
dorsal to the ninth dorsal inclusive, which locates the 
vaso motor centers. On the right side, the apex of the 
triangle points to the word "stomach," and the base of 
the triangle formed from the sixth to the ninth dorsal 
inclusive. This locates the points where pain or tender- 
ness can be found by palpation, which requires either 
Osteopathic or vibratory treatment. These areas are 
recognized by both the Osteopathic and Vibratory 
therapeutist; the only difference is in the method by 
which the treatment is applied. The Osteopath utilizes 
his fingers, and the physician the vibrator; equal results 
can be obtained, in many cases, by either means. The 
Osteopath has the advantage, however, as his instru- 
ments (his fingers) are always with him and he does 
not have to depend upon electric motive force. 

In treating the spinal nerve centers, the seventh 
cervical vertebra, known as vertebra prominens, is 
always used as a "land mark" to count from. When 
locating special areas, the left hand can trace the ver- 
tebra while the right hand can apply the vibration. In 
treating the different areas and organs of the body, 
the following table is the generally accepted technique: 

Head and Neck. — For pain in these locations, vibra- 
tion should be applied from the third cervical to the 
fifth dorsal, inclusive. 

Arms. — Vibrate from the third to- the seventh dorsal, 
inclusive. 

Heart. — Vibrate from the third cervical to the fifth 
dorsal, inclusive, and tender spots may be located at the 
first, second and third dorsal. 

Lungs. — Vibrate from the third to the seventh dorsal ; 
tenderness may be located from the first to the fifth 
dorsal ; inclusive. 

Stomach. — Vibrate from the second to the ninth 
dorsal ; tenderness from the sixth to the ninth dorsal. 

Spleen. — Vibrate from the third dorsal to the first 
lumbar, inclusive, especially the fifth, sixth, seventh, 



VIBROTHERAPY. 



89 



Itl Cenn- 



Heart 




estis and Epidymis 



Uterus 



Rectum 



90 VIBROTHERAPY. 

eighth and ninth dorsal on the left side sensitiveness 
will 'be detected on the left side from the fifth to the 
ninth dorsal vertebra. 

Liver. — Vibrate from the third to the eleventh dorsal, 
especially from the fifth to the ninth on the right side. 
Tenderness will be found from the seventh to the tenth 
on the right side. 

Pancreas. — Vibrate from the fifth dorsal to the first 
lumbar, inclusive. 

Kidney and Ureters. — Vibrate from the fourth dorsal 
to the fourth lumbar. Tenderness will be located from 
the tenth dorsal to the first lumbar, inclusive. 

Bladder. — Vrbrate from the eleventh dorsal to the 
fourth sacral, inclusive, and look for tenderness over this 
area. 

Prostate. — Vibrate from the first lumbar to the fifth 
sacral ; look for tenderness from the tenth dorsal to the 
third sacral. 

Uterus and Vagina. — Vibrate the lumbar nerves and 
also look for pain or tenderness at this region. 

External Genitals. — Vibrate from the twelfth dorsal 
to the fourth sacral ; tenderness over the same region. 

Intestines. — Vi'brate from the sixth dorsal to the first 
lumbar, inclusive ; tenderness from the ninth to the 
twelfth dorsal. 

Colon and Rectum. — Vibrate the sacral nerves and 
look for tenderness at the second, third and fourth 
vertebra. 

Anus. — Vibrate from the twelfth dorsal to the fourth 
sacral ; tenderness over same area. 

Legs. — Vibrate from the eleventh dorsal to the third 
lumbar, inclusive. 

Skin of the Body. — Vibrate from the first dorsal to 
the fourth lumbar, inclusive. 

Testis Epidymis and Ovary — Vibrate from the eighth 
dorsal to the fourth sacral; tenderness will be found 
from the tenth dorsal to the first lumbar. 

In maintaining the normal functions of the body, in 
which health may be considered the standard, we have 



VIBROTHERAPY. • 91 

four principal factors, which are of the greatest im- 
portance ; the nerve and blood supply, absorption and 
elimination. These organs and functions are especially 
favorably influenced by vibratory massage, often re- 
quiring treatment in both a direct and indirect way; 
that is, we can control these functions in what may be 
considered an indirect or reflex way, through the nerve 
centers of the spinal column, and can assist elimination 
by vibrating directly over the part. To illustrate: the 
most obstinate cases of constipation can be relieved by 
either of three methods, or better still, the three com- 
bined. First, by stimulating the nerve centers in the 
spinal column, from the sixth dorsal to the twelfth, in- 
clusive, and the third, fourth and fifth lumbar, and the 
first, second and third sacral. It is always a good plan, 
however, to vibrate from the fifth dorsal down to the 
coccyx, on both sides of the spinal column, pressing 
the ball applicator firmly in at the side of the spinous 
processes. Great care should be exercised not to vibrate 
too long, or to make too heavy pressure ; the percus- 
sion stroke is used from eight to ten seconds. An im- 
portant thing to remember is that too long and heavy 
stroking will inhibit and produce constipation, while 
the short strokes, repeated frequently over the same 
areas, during the treatment period, will produce stimu- 
lation, which is the result desired. 

The patient is now changed from the abdominal to 
the dorsal position, with his knees drawn up, to relax 
the abdominal muscles; this is the preferable position in 
abdominal and thoracic treatments. . Direct stimulation 
may now be applied over the liver, to increase the 
activity of that organ ; the brush or flat applicator is 
preferable, with a lateral or rotary stroke. 

The colon is the next organ to occupy our attention, 
starting at the cecum, and following the course of the 
ascending transverse and decending bowel, dwelling 
only a few seconds at each point, and continuing the 
course of the vibrator in a spiral or rotary movement, 
(see illustration). This course should be followed sev- 



92 VIBROTHERAPY. 

eral times during each treatment, which is more effec- 
tual than one treatment, applied at length. The patient 
should now be placed in the Sim's position, for direct 
vibration to rectum and lower bowel. For this purpose 
the vibratodes G. and O., may be used, and the medium 
rotary or lateral stroke is to be employed, (the per- 
cussion stroke is absolutely of no value), by making 
firm pressure against the anus for thirty or sixty or 
more seconds. At the termination of the treatment the 
patient will usually experience a desire to evacuate the 
bowels; which, of course he should be allowed to-do. 
The value of vibratory massage may be summarized as 
follows : 

The Blood, which in all instances may b% considered 
the first, and to the injured, a very important element, 
as it is through this vital fluid that all processes of 
healing take place, and by controlling and equalizing 
circulation, we generally maintain health. Wherever 
obstruction of circulation is observed, we find conges- 
tion, inflammation or perhaps abscesses. Obstruction 
to the veinous circulation is the most frequently met 
with, and nearly always present in many forms of heart, 
lung, liver and kidney diseases; as an adjunct to other 
therapeutic measures vibratory massage is indispen- 
sable. 

The Lymphatics perhaps hold the second place of the 
important organs to which vibratory therapeutics are 
successfully applied. These glands - are divided into 
two sets, the superficial and deep seated ; the former lie 
just beneath the skin, in the loose connective tissue, 
and are found in the neck, axillae, front of elbows, 
groin, popliteal space, etc., the latter follows the course 
of the large blood vessels, and are found on both curva- 
tures of the stomach, in the mesentery, liver, spleen, 
kidneys, uterus, bladder, etc. These glands are often 
referred to as the scavengers of our body. 

When disease attacks any special area of the body 
these glands become at once involved, often obstructing 
their functions. It is plain to see the importance of 



VIBROTHERAPY. 93 

vibratory stimulation as an adjunct therapeutic measure 
to open up this drainage outlet, and unload the sys- 
tem of toxic material, through the eliminative process. 
A very important thing to remember is that all vibra- 
tory movements, pertaining to the circulatory system, 
should be made towards the center; that is, the 
blood vessels should be vibrated towards the heart, 
and the lymphatics should be vibrated in the direction 
of the lymph flow. The vibratode simply acts like a 
pump, by forcing the. blood and lymph onward in their 
natural course, which not only relieves the system of 
toxic influences, but stimulates the organs to new life 
and activity. 

The Nerves. — Having previously discussed the tech- 
nique of vibratory massage, upon the spinal nerve cen- 
ters, we find it often necessary to apply direct vibration 
to nerve trunks, in many pathological conditions. The 
pneumogastric nerve emerges from the cranium, at the 
jugular formum, and passes down the neck, in the 
sheath of the carotid artery and is best reached along 
the inner border of the sterno-cleido-mastoid muscle 
(see illustration). It should be borne in mind that 
prolonged stimulation of this nerve slows the action of 
the heart, even to the stage of fainting, and such treat- 
ment should not last over ten or twenty seconds. The 
sciatic nerve can be reached along its course on the 
posterior thigh, and also back of the great trochanter, 
(see vaso-motor centers). The solar-plexus is best 
reached and influenced by vibrating upwards and down- 
wards about two and one-half inches, on both sides of 
the umbilicus; commence just below the umbilicus, and 
vibrate upward to the rib line, and downward from this 
point. Headache and neuralgia are nearly always re- 
lieved by prolonged vibrating directly over the painful 
area; frontal headache is best relieved by vibrating over 
the super orbital notches. 



94 



VIBROTHERAPY. 




VIBRATORY AREAS OF CHEST AXD ABDOMEN. 



1. Pneumogastric Nerve. 2. Chest. 3. Sternum. 4. Solar Plexus. 5. Small 
Intestines. 6. Colon. 



VIBROTHERAPY. 95 

ABDOMINAL VIBRATION. 

We have already described the method of vibrating 
the colon. The small intestines may be stimulated to 
activity by commencing at the umbilicus, and following 
a circular course to the cecum. It is well to follow this 
course, previous to vibrating the colon, for stomach dis- 
orders and inactivity of the bowels. 

Vibrating the Chest. — In vibrating the chest the 
patient should be placed upon his back, and his hands 
clasped back of his head. The brush applicator is pre- 
ferable, for these movements commence from the in- 
ferior maxillary, and stroke downward to the clavical ; 
the inter-costal spaces of the sixth upper ribs should 
be treated towards the sternum and the spaces below. 
(The short arrows, on the accompanying cut, will illus- 
trate the course to pursue). The sternum itself can be 
stroked either up or down. 



96 ELECTRO-THERAPEUTICS. 



Electrotherapeutics 



When Benjamin Franklin was conducting his ex- 
periments with electricity, with a kite and key, the 
people would ask: "Of what use is it, anyway ?" 
"Never mind," retorted the old philosopher, "It's only 
a baby now; it might grow to be a man some day." 
The present generation is living in an age to witness 
his prediction come true, and electricity has not only 
grown to be a man, but a giant, in both the commercial 
world and as a therapeutic measure. Ever since Gal- 
vani's experience, related on another page, electricity 
has been steadily growing in favor as a means of treat- 
ing diseases and alleviating suffering. Electricity, like 
many other things introduced in medicine, has in for- 
mer years, been but little understood, and therefore, too 
much has been expected from this influence. As science 
progresses, however, and we learn more of the nature 
of this element, we are able to utilize it in therapeutics 
to a better advantage. It is not what electricity has 
accomplished; it is what it has not accomplished that 
has made some practitioners depreciate its value. Like 
all other things of a physical nature utilized in treating 
diseases it has its special sphere of operation, and the 
better we learn to identify its sphere and utilize its 
application in practical ways, the more competent we 
are to use this agent in the treatment of disease. 

One of the most confusing things regarding the use 
of electricity is: there seems to be no absolute stand- 
ard or set laws for its use. One operator will accom- 
plish results by one method of application, and another 
will accomplish the same results by another, so when 
stereotyped rules are laid down for manipulating the 
currents, the amateur electrotherapeutist is at once con- 



ELECTRO-THERAPEUTICS. 9T 

fronted by the perplexity of technique. Difference of 
opinion, however, is the spice of argument, and if each 
observer did not air his views, the entire practice of 
medicine would be a one sided affair. We would have 
no more idea of reaching- the facts than preachers have 
of piloting sinners to heaven, through the different 
denomination routes. 

I fully realize that electrotherapy offers too broad 
a scope to be completely discussed in a publication of 
this kind; yet the fundamental principles may be suf- 
ficiently outlined to induce the reader to delve more 
thoroughly into the subject, as no office practitioner 
could possibly think of successfully conducting an office 
practice, without including this valuable agent with his 
armorment against disease. Perhaps the only word of 
caution I should give, is not to accept this agent as a. 
panacea for all ills, a mistake made by many over en- 
thusiastic practitioners. 

Electricity, like the. other physiologic methods in the 
preceding chapters, has its circumscribed field of opera- 
tion, and outside of this, it is of little or no value, and 
often does more harm than good; when not properly 
understood ; therefore, to be an Electrotherapeutist does 
not simply mean to be the possessor of an elaborate 
outfit of electrical machines or apparatus to display for 
commercial purposes, as does the charlatan with the 
buzzing from his Faradic battery, but to understand 
the construction, mechanism and generative forces they 
possess, to manufacture and to supply this force, known 
as electricity, and, after this force is harnessed by 
special apparatus, to dispense it in the different forms 
or currents, where it can be utilized to the best advan- 
tage in the treatment of disease. 

The first question a student, contemplating the study 
of electricity would ask: what is electricity? The word 
electricity is derived from the Greek word Electron, 
meaning amber; as the ancient sailors discovered, by 
the friction of amber and similar substances various 
attractions, repulsions, sparklings and other phenomena 



98 ELECTRO-THERAPEUTICS. 

were manifested. Most scientific men hold the view 
that electricity is ether itself, which is the elastic in- 
compressible medium pervading all space; conveying 
luminous and other vibrations, and that the phenomena 
of positive and negative electrifications are due to dis- 
placement of the ether, at the surface of bodies. 

The researches of Hertz, who, by direct experiments, 
verified Maxwell's brilliant theory that electrical action 
is propagated through space by wave motion of the 
ether, differing only in respect of wave length and 
period from the vibrations which constitute light, have 
been of the utmost value in helping to arrive at a 
solution of the problem. 

Investigations into the phenomena of electric dis- 
charges in high vacua, followed by the discovery of the 
X-Rays have also thrown much light on the subject. 
The general conclusion is, that ether is electricity in an 
invisible or passive state, and the only way to convert 
it into energy is to destroy its equilibrium, as is demon- 
strated in various ways, from the simple ruffling of the 
fur on a cat's back, to the friction of clouds, during a 
thunder storm. 

For therapeutic purposes, this energy is generated 
by chemical decomposition and other means, and is 
conducted and controlled by different electrical appar- 
atus and machines, which are known and referred to as 
batteries. 

A complete analysis of electro physics and technique 
is too exhaustive to fall within the scope of this publi- 
cation, and it is generally understood that most phy- 
sicians are familiar with these subjects; we will there- 
fore devote only a few pages to a brief discussion of 
electric currents, etc., and give the technique of their 
use in the diseases, as these are specified. 

The language of electricity, the same as any other 
science, is the first to become familiar in investigating 
the science. The nomenclature of electrotherapeutics, 
like any other science, undergoes certain changes from 
time to time, as the science progresses, and in order to 



ELECTRO-THERAPEUTICS. 



99 



comprehend the meaning of these terms, we must learn 
what they incorporate. Many of the terms used in 
electricity were named after the men who established 
their principles. 




MODERN WALL CABINET. 



GALVANIC ELECTRICITY. 

Was founded by Galvani, the Italian anatomist, 
about Ii3'2 years ago. This form of electricity is also 
referred to as the direct, or continuous current, and is 
one of the most simple means of converting chemical 
decomposition into electrical energy. 



1 00 ELECTRO-THERAPEUTICS. 

A galvanic cell consists of a plate of carbon, and a 
plate of zinc, immersed in an exciting fluid. There are 
several chemicals or combinations of chemicals used 
for this purpose, of which the following is one: 

Bichromate of potassium 2*4 oz. 

Sulphuric acid 3 oz. 

Mercury bisulphate 120 gr. 

Water 16 oz. 

By connecting two or more of these cells together, 
we obtain sufficient electro-motive force for all thera- 
peutic purposes, and this forms the type of battery most 
suitable for the physician living in the country, where 
he does not have access to the public lighting systems 
of the city. The most convenient way, however, is to 
utilize the 110 volt direct current from the city lighting 
system, providing this current is furnished ; most cities, 
however, have only the alternating current, and in such 
circumstances, a small rectifier, (see cut), is used to 
transfer the current from an alternating to a direct cur- 
rent. This form of electricity is one of the most valu- 
able in electro-therapeutics, as it has the greatest field 
of usefulness in electrolysis and cataphoresis. 



DIFFERENCE IN POLAR EFFECTS. 

The galvanic current is generated by chemical de- 
composition in the galvanic cells which takes place at 
the surface of the zinc plate, and is therefore, the posi- 
tive element within the cell, as the current flows to- 
wards the carbon plate, which makes this the negative 
element, outside of the cell. It is just the opposite, 
the carbon terminal is called the positive pole, and the 
zinc terminal the negative pole. These two poles, used 
for therapeutic purposes, are decidedly different in their 
effects. 

The positive pole is often spoken of as the acid 
pole, and has a caustic effect which hardens tissues with 



ELECTRO-THERAPEUTICS. 101 

unyielding cicatricial tissue; is a vaso constructor and 
will stop bleeding, and is sedative in its effects. 

The negative pole is often referred to as the alkaline 
pole, and acts as an alkaline caustic. It softens, disin- 
tegrates and liquefies tissues, with very little resultant 
cicatricial tissue, which is more soft and pliable. It is 
a vaso dilator, and likewise increases bleeding and pro- 




ALTERNATING CURRENT RECTIFIER. 

duces hypersensitiveness. Their polar effects, which are 
decidedly opposite, are among the first things to be 
understood in handling electric currents, and we can 
readily see why the old doctors, who would advise "If 
one current don't do the business, try the other," were 
so erroneous in their methods and disappointed in their 
efforts ; nowadays the physician's reputation is at stake 
in selecting the right pole for the condition, in which it 
is indicated. 



102 ELECTRO-THERAPEUTICS. 

ELECTROLYSIS AND CATAPHORESIS. 

Both these functions are derived from the galvanic 
current, and constitute two of the most important 
methods of utilizing this form of electricity. 

Electrolysis is the process of separating, or decom- 
posing elements by electricity, and we have at our dis- 
posal an alkaline or acid radical, which may be used as 
the case demands, by using the different poles of the 
currents. For electrolytic work, however, the negative 
pole is always used, because it acts as an alkaline caus- 
tic, and leaves the tissues soft and pliable, while the 
positive pole hardens the tissues and may result in un- 
sightly scars ; therefore, the negative pole is preferable 
in the removal of superfluous hair, warts, moles, navi, 
etc. 

Cataphoresis is the process of conveying medicines 
into the tissues of the body by means of the continuous 
current; thus, thiosinamine is used to dissolve scar 
tissue. Potassium iodide is used, to excellent advantage, 
to reduce glandular enlargements, particularly in goiter; 
local anaesthesia may be induced by the use of cocaine, 
etc. These solutions are always used on the negative 
pole and will be referred to later. 

FARADIC ELECTRICITY. 

('Magnetism.) 

Was first devised by Michael Faraday, of England, 
in the year 1831, from whom it takes its name; but at 
the present time, is more frequently referred to as the 
induced or interrupted current. There are three ways 
of supplying this electric force. The first is the lode- 
stone, or natural magnet, and the second by means of 
wrapping a coil or coils of insulated wire around a cone 
of very soft iron and charging the wire with an electric 
current. The third, or static induced current, is taken 
from the outside coating of Leyden jars, attached to a 
static machine. 

This form of electricity is used for its general tonic 



ELECTRO-THERAPEUTICS. 103 

effect upon tissues, by causing the muscles to contract, 
the blood to circulate more freely, and as a general 
stimulant to metabolism. 

Dr. Homer E. Bennett, briefly states the physics, 
physiology and therapy of the induced current as fol- 
lows: 

The primary faradic current is really an interrupted 
galvanic current with the added magnetic properties 
imparted to it, from its immersion in the electro-mag- 
netic field of the core, which gives it more potential. 
The primary has but little power of penetration and, 
therefore, the effects are superficial and its usefulness 
limited, but, when a paralyzed nerve is superficial, it 
may be stimulated by the primary current. 

On account of the amperage or current strength of 
the primary, it will cause powerful contractions of the 
superficial muscles. This current is more stimulating 
and irritating than is the secondary, hence it will in- 
crease the capillary circulation in the skin and" is used 
to good advantage in this way as a tonic stimulant in 
conjunction with the electro-vapor bath. The primary 
current is uni-directional, but is interrupted with the 
frequency corresponding to the "make" and "break" of 
the vibrator. Coming from the primary cells, it has 
feeble galvanic properties, being both electrolytic and 
phoric to a slight degree, but its chief action upon the 
living organism is as an excitant to contractile tissue 
and a stimulant to sensory nerves, by reason of the 
interruptions, which cause sudden variations of the 
potential. The very suddenness of this change in the 
electro-motive force makes this current a powerful 
stimulant for exciting muscular contractions and arous- 
ing the action of the sensory nerves and the promotion 
of tissue metabolism. 

The secondary induced current differs radically from 
the primary in every way, both in production and 
effects. The secondary coil current is the purely in- 
duced current and has no available amperage or current 
strength, and, therefore, no electrolytic (chemical), or 



104 ELECTRO-THERAPEUTICS. 

any phoric effects. Through the process of induction 
the voltage is enormously increased, so that it has 
great power of penetration, and will influence deep- 
seated conditions. 

On account of the rapid hysteresis in the primary 
field, there is produced a fluctuation in the secondary 
potential, which imparts to the secondary coil current 
to-and-fro or alternating character. Therefore, the 
secondary current has no fixed polarity, but there is a 
difference in the rise and fall of this potential, which 
gives to it a slight polar effect, but which is entirely 
mechanical. 

The current induced by the "make" is slower than 
the reverse current induced by the "break," in the pri- 
mary. The electro-motive force is varied by the rapid- 
ity of the interruptions and by the size and length of 
the wire on the secondary coil. If the interruptions are 
very rapid and the coil composed of many turns of fine 
wire, the resulting current, though interrupted, begin to 
resemble, in physical properties, the sinusoidal modality. 
The approach to and departure from the highest and 
lowest potential, in each period, is, by this construction, 
made more gradual, and the physiological effects are as 
stimulants and not irritants, therefore, it is a tonic and 
sedative to both motor and sensory nerves. 

This current is what constitutes the so-called "high 
tension" current, which has a decided analgesic or 
anaesthetic effect, and will relieve pain. 

The secondary current will contract muscles, the 
interruptions being so rapid that the muscles do not 
have time to relax between the interruptions, there- 
fore, the muscles will remain in a state of clonic spasm 
as long as the current flows. There being no chemical 
effect to the secondary current on account of the ab- 
sence of amperage, the pain is relieved in an irritated 
nerve through a process of tetanization of the nerve. 

The current from a short, coarse secondary coil is 
rough, harsh and irritating, and. therefore, painful, and 
when ignorantly or carelessly applied is often injurious. 



ELECTRO-THERAPEUTICS. 105 

The cheap batteries, commonly found in the stores and 
sold to the laity for self-treatment, are usually of this 
character, and by them many have been "shocked" till 
they are fearful of all kinds. 

In some cases of paralysis, where it is desired to get 
powerful stimulation, this current is indicated. Like- 
wise in cases of narcosis, drowning, asphyxia, poison- 
ing, etc., this current may be used to advantage to 
induce and keep up artificial respiration. 

The best induction coil for the general practician or 
electro-therapeutist is one in which the strength of the 
primary can be changed and in which the number of 
the primary interruptions may be regulated, by means 
of both slow and rapid vibrators, and in which the 
secondary contains at least 3,0-00 feet of No. 36 wire 
and with another thousand or fifteen hundred feet more, 
which may be added when desired, for the sedative 
effect. The primary coil should have about 200 feet of 
No. 20 wire. 

The primary currents are useful in producing super- 
ficial stimulation, equalizing capillary circulation, and in 
giving general tonic treatments. 

The coarse secondary coil currents are indicated for 
powerful stimulation, such as for massage effects in 
atrophy, paralysis, perversion of cutaneous sensibility, 
and in relaxed and sluggish states of the bowels, and 
glandular systems, narcosis, etc. 

The high tension or long, fine wire coil currents are 
indicated in deep-seated nervous and painful conditions, 
as ovaritis, neuralgia, and sub-acute and chronic en- 
gorgements, due to vaso-motor paralysis, and in de- 
praved states where there is need of stimulation of tis- 
sue metabolism and retrograde metamorphosis. 

THE SINUSOIDAL CURRENT. 

The Sinusoidal current is one of the three forms of 
induced currents used in medicine, and differs from the 
faradic and static induced, inasmuch as the alternations 



106 



ELECTRO-THERAPEUTICS. 



produced are smooth and even, instead of rough and 
irregular in character. Of the three alternating cur- 
rents the Faradic is the most unsatisfactory, as it pro- 
duces muscular contraction with such force as to be 
painful with many delicate subjects. The static induced 
current will produce muscular contraction, with less 
pain, but is more difficult to control. The Sinusoidal 
current will accomplish the same results as the two 
former currents, and produce powerful muscular con- 
tractions, with but little or no discomfort to the patient, 
and when compared with the other interrupted currents, 
is like the calm rolling tide of the ocean, after a storm, 




POLY SINE GENERATOR. 



and is particularly indicated in atonic visceral condi- 
tions. We have no more effectual agent than the Sinu- 
soidal current. Its peculiar properties of exciting con- 
traction, 'both of striated and nonstriated muscular tissue 
painlessly, makes it invaluable in the treatment of 
Chronic Gastro-Intestinal disorders. It will relieve the 
most obstinate cases of constipation which have re- 
peatedly failed to be more than temporarily benefited by 
other methods. 

In Chronic Cystitis, especially those cases associated 
with enlarged Prostate, the results are particularly gra- 



ELECTRO-THERAPEUTICS. 107 

tifying, and when used alternately with the constant 
current, the final result will be more than satisfactory, 
to both physician and patient. 

Seminal Vesiculitis, Prostatitis, Varicocele, Atrophied 
Testicles, in fact any condition where there is loss of 
tone, or nutrition is impaired, the Sinusoidal is the cur- 
rent par excellence. 

All forms of Neuritis, whether acute or chronic, and 
many Neuralgias, are cured, where the use of other cur- 
rents has proven unavailing. 

The remarkable properties, tonic, stimulant, and 
sedative, produced by this current, together with its 
profound effect on nutrition, make it an almost indis- 
pensable addition to the armamentarium of the phy- 
sician. 

STATIC ELECTRICITY. 

With static electricity we have a form of electric 
energy which consists of nearly all voltage, and very 
little or no amperage, and while the body of the patient 
is required to come in contact with both poles of the 
continuous or induced currents, in this form of electric 
procedure, the electric charge may be forced in local 
areas with one pole, and conducted through the body to 
the other pole, through the ground or air, at a long dis- 
tance; therefore, we may administer the local effects of 
electric currents to circumscribed areas, by the use 
of special constructed electrodes, while the entire body 
is being charged with a high potential current, which is 
extensively used for its tonic effect, and a process of 
increasing cell metabolism, in the treatment of many 
organic and functional diseases. 

One of the most popular forms of treatment with 
static electricity, is called the breeze treatment, or the 
static bath, which is given to the patient on an isolated 
platform, connected with one of the static jars, while 
the other jar is connected with a crown electrode above 
the head. The influence of this current is very sooth- 



108 



ELECTRO-THERAPEUTICS. 



ing to many patients, as it gives the sensation of a 
gentle breeze to the head, and acts as a sedative, and 
often relieves headache and induces sleep ; in brief, it 
tranquilizes and equalizes the nerve^forces, dilates the 
cutaneous vessels, and hastens the elimination of waste 
products, carbon dioxide, urea, etc. 




STATIC MACHINE. 



ROENTGEN OR X-RAYS. 

It was in the year 1895, W. C. Roentgen, announced 
to the world the discovery of invisible, non-refrac- 
tible rays, eminating from the surface of an electrically 
excited vacuum tube, opposite the cathode electrode, 
having the power of permeating objects impervious to 
light or heat rays, and affecting photographic plates in 
a manner similar to light rays. Not being certain as 
to the nature of these rays, he provisionally termed them 
"X-Rays" and, although seventeen years have elapsed 
since their discovery, we are still ignorant of their 
true nature. The X-Ray has not only served the sur- 



ELECTRO-THERAPEUTICS. 



109- 



geon as a valuable means of locating foreign bodies, 
dislocations and fractures, but is one of the most valu- 
able means we have for the treatment of certain cutan- 
eous conditions and cancer; recent investigations have 
proven such remarkable results that the most radical 
claims may not be impossible of realization. 




X-RAY GENERATOR. 



HIGH FREQUENCY CURRENTS. 

This form of electric currents was introduced by 
Nikola Tesla, in the year 1900, and is referred to, 
synonymously, as the "high frequency" or "Tesla cur- 
rents" which is an oscillating current, in which the fre- 
quency is beyond the point of producing muscular con- 
tractions. Muscular contractions, cease with 10.000 
oscillations, which has been taken as the dividing line 
between medium and high frequency currents. Many 



110 ELECTRO-THERAPEUTICS. 

of the high frequency apparatus are estimated to develop 
over a million oscillations. This current may be devel- 
oped from a static machine with the addition of an 
Oudin resonator, or by securing a special high fre- 
quency coil of which there are many elaborate outfits on 
the market. 



OZONE THERAPY. Ill 



Ozone Therapy 



Ozone is another product of nature, which is fast 
gaining the confidence of the Medical Profession, as a 
natural therapeutic agent, and, while nearly all 'Sani- 
tariums utilize this adjunct, many office specialists do 
not consider their equipment complete without the addi- 
tion of an Ozone generator. Van Marum was, per- 
haps, the first to identify this gas; although Prof. 
Schoenbein, was the first to give it its present name, 
and christen this agent for therapeutic purposes, in the 
year 1845, but owing to a deficient means of generating 
this gas, very little was done to advance its therapeutic 
value, until within recent years, but at the present time, 
the manufacturers of ozone producing machines are 
keeping pace with other inventive skill, and we have 
offered us many reliable mechanical devices, which the 
physician can utilize, to supply ozone to the class of 
disease in which it is indicated. 

All electric currents produce ozone to a certain ex- 
tent, but in order to generate it in sufficient quantities 
to be dispensed for its specific influence, it is well to 
understand the process of liberating this gas. When- 
ever an electric spark passes through the air, ozone is 
liberated, and at the same time, nitrous gases and 
oxides are produced, which are injurious to inhale. It 
has been demonstrated that the less perceptible spark 
accompanying the production of ozone, the less amount 
of these objectionable gases it will contain. 

The static machine was formerly used for the pur- 
pose of producing ozone, but owing to the poisonous 
by-products, mentioned above, this means of generat- 
ing ozone has been abandoned for the modern ozone 



112 OZONE THERAPY. 

generator where these poisonous gases are eliminated 
by filtering the ozone through balsamic oils, which not 
only adds to the agreeableness of the treatment, but 
also to the curative effect of the ozone itself. The fol- 
lowing is a favorite formula for the filtering oils. 

Oil of pine 2 parts 

Oil of eucalyptus 1 part 

These oils, after being in use sometime, to purify 
the ozone, are used in the treatment of many skin 
diseases and indolent ulcers, for which they make a very 
valuable dressing. Some advertising physicians have 
attempted to promote their sale under the name of 
"Ozone Oils," etc. 

Ozone may be administered to the patient by direct 
inhalation, through rubber tubes, from the ozone gen- 
erator; or, many physicians equip a small room in their 
offices or Sanitariums, which they call "The Inhalator- 
ium," and allow their patients to occupy this room cer- 
tain hours of the day, and many sleeping rooms in 
Sanitariums are impregnated with ozone through the 
night; thus providing the "mountain air" in any locality 
which, in my opinion, is the best way to supply this 
therapeutic agent. 

Where patients visit the office and inhale ozone 
direct from the generator, there can be no stated time 
allowed for each treatment, as some cases may require 
longer inhalations than others ; therefore the direct in- 
halation is the best means of treating acute attacks of 
Bronchitis, Asthma, etc., but the continuous supply of 
ozone in the inhalatorium or sleeping room is the best 
means of treating chronic diseases of the air passages, 
and especially consumption, where the continuous in- 
fluence of this agent may be obtained. 

Ozone is an allotropic form of oxygen, and is fre- 
quently referred to as a purified, or a highly energized 
form of oxygen. It will readily be seen what a large 
field of influence such an agent will have on animal life, 
in oxygenizing the blood and tissues of the body. As 
a blood builder and reconstructive it has no equal. Its 



OZONE THERAPY. 



113 



bacteriacidal properties have long been recognized, and 
many public places use ozone to purify the air and 
water, as ozone will rapidly destroy the most objection- 
able odors. The germs in sewers have been reported 
destroyed to the extent that the filtered water is suit- 
able for drinking purposes. 




OZONE GENERATOR. 



Ozone can never be recognized as a specific cure for 
any disease, but like many other things in physio- 
therapy it has its special sphere of usefulness, and when 
employed in conjunction with other therapeutic meas* 



114 OZONE THERAPY. 

ures, it aids the natural processes by restoring health. 
In other words, it is one of the reinforcements to other 
therapeutics, in their battle against disease. It might 
be stated that ozone is indicated in all diseases, for pure 
air is essential in restoring all forms of low vitality. 
Its special sphere, however, is in the class of diseases 
which can be treated through the absorbent processes 
of the air passages. By inhaling ozone we sterilize the 
air passages, and fortify the lungs against invading 
bacteria; hence, its usefulness in tuberculosis and infec- 
tious diseases of the air passages. Its oxidizing effect 
upon the blood makes it of the greatest value in the 
treatment of anaemia and chlorosis ; also, other forms 
of impaired nutrition, whooping cough, asthma, hay 
fever, and bronchitis are always greatly benefited by 
inhalation of ozone, Syphilis, and other morbid condi- 
tions of the blood and tissues, rapidly improve under 
the influence of this therapeutic agent, and although 
its sphere of remedial value is more pronounced in 
some diseases than others, it has a universal usefulness 
in all forms of animal life. 



MEDICAL AND SURGICAL SPECIALTIES 115 



Medical and Surgical 
Specialties 



In considering the Medical and Surgical specialties, 
which are suitable for an office practice, it is generally 
understood that the physician in charge has ceased to 
be a free bureau for general advice and distributing 
agent for invalids, as was the former custom of many 
general practitioners, who would dispose of their cancer 
patients to some cancer specialist or hospital ; would 
allow their hernia patients to drift into the hands of 
some advertising "Rupture Specialists" ; would send 
their throat and nose patients to some "Larnygologist," 
etc., while there are many learned and esteemed special- 
ists throughout the country at this age of modern thera- 
peutics, appliances and apparatus which are accessible 
to every physician, and the most excellent text books 
on all subjects of medicine and surgery are at his dis- 
posal, and by becoming familiar with the manipulation 
of one, and the technique given by the other, any phy- 
sician of ordinary skill can, within a comparatively short 
time, cope with many diseases and conditions which it 
was formerly thought, should be treated by the "city 
physicians." Of all the physicians in the world the 
country general practitioner is the most resourceful, and 
has in the past years, been compelled to adapt himself 
to circumstances and conditions ; now that mechanical 
ingenuity has placed these modern therapeutic agencies 
within his reach at a reasonable outlay of money, and 
medical writers have given him the best of their know^ 
ledge and experience, there is no reason why every 



116 MEDICAL AND SURGICAL SPECIALTIES 

physician should not incorporate the treatment of many- 
diseases in his practice that was formerly sent to the 
specialists, and receive the financial returns to which he 
is justly entitled. 

In adopting the office specialties, his first step is to 
become familiar with the physiologic apparatus outlined 
in the foregoing chapters, and the technique of their 
use ; he should next endeavor to utilize them to the 
best of his ability, in connection with all the Medical 
and Surgical specialties which he can successfully mas- 
ter, and it is hoped, some of the minor specialties given 
in the following pages may render him some assistance 
in this field of labor. 

There are two ways of specializing in medicine ; one 
is to master the disease of one or two organs, or groups 
of organs, and the other is to master all the diseases 
possible, irrespective of their organs. 

There are very few physicians who have not enter- 
tained the idea that some time they would specialize, 
but could not decide on any particular specialty, think- 
ing each field overcrowded ; this is quite true in many 
respects, for our cities^ contain nearly as many special- 
ists as they do general practitioners ; therefore," he who 
has hesitated is lost." 

In choosing specialties such as this publication is 
endeavoring to present, we would naturally select such 
diseases as are the most prevalent and frequently met 
with in office consultations. Very few physicians would 
care to specialize in the treatment of disease of the 
spleen, because he would be better remunerated for his 
services if he successfully treated the diseases peculiar 
to women, as this field is rich in clinical materials. It 
has been stated that every woman has some form of 
female weakness, therefore our fashionable gynaecolog- 
ists are among the best salaried physicians in the 
country, and we often wonder why the late Dr. W. 
Todd Helmuth was inspired to write the following 
verse: 



MEDICAL AND SURGICAL SPECIALTIES 1V< 

"But 'mid these varied callings all, 
The man that heads the list 
Is the gentle fingered ge-ni-us, 
The Gy-ne-col-o-gist. 
He is such a charming fellow, 
So clever in his way; 
He always thrives in cities, 
We meet him every day. 
His rooms are over-crowded 
With ladies, quite a host; 
And, if he has a wife, they trust 
She'll soon give up the ghost." 

In selecting the profitable office specialties we natur- 
ally select the diseases which are the most common. 
The social evils offer a large scope, therefore, genito- 
urinary and venereal diseases make a profitable spe- 
cialty. Statistics show that every eleventh man, and 
every eighth woman, over forty years of age, have can- 
cer. Every tenth adult person has some form of rectal 
disease ; every twelfth man, past thirty-five years of age, 
is ruptured. Visit any public place and observe the 
number of deformities and blemishes of the face, which 
should be corrected or removed ; review the number of 
alcohol and drug habitues, living in your immediate 
vicinity, that could be encouraged to abandon their 
habits through the treatment you could administer. 
These, together with the long list of chronic ailments, 
rheumatism, catarrh, and all throat, nose and lung 
diseases of the prima viae and nervous system, are the 
class of diseases which can be successfully incorporated 
in an office practice, and with a very few exceptions, 
these ailments can be as successfully treated by the 
office practitioner as they may be by many self-styled 
"specialist" who boast of their superior skill in the 
treatment of various diseases. 



118 



HYPODERMIC MEDICATION 



Hypodermic Medication 



Of all operations which come within the domain of 
surgery, the use of the hypodermic syringe is perhaps 
the most insignificant, yet if we watch many practi- 
tioners use this valuable little instrument, we hang our 
heads in shame, for their absolute neglect in observing 
the antiseptic principles with 
which this instrument should be 
used. Many surgeons are pro- 
nounced cranks regarding sur- 
gical cleanliness of their knives 
and other instruments, but they 
evidently think the hypodermic 
needle is too minute to be con- 
sidered to any great extent; an 
adder's fangs are small, yet 
when they deposit poison under 
the skin, its toxic influence is 
realized, and the same is true 
with any other instrument, 
which penetrates the integument. 
Inasmuch as this little instru- 
ment renders- important services 
for the office specialist, we will 
briefly outline some of the prin- 
ciples involved in its construc- 
tion and use. 

I always prefer the old style 
of glass cylinder syringe (given 
in the accompanying illustra- 
tion), which embodies the fol- 
lowing parts: 1, large, flat, pis- 
ton head that the thumb may 
make heavy pressure ; 2, gradu- 
ated piston stem, which divides 
the contents of the barrel into minims. It is well to 




HYPODERMIC MEDICATION 



119 



remember that in speaking of "minims" in the fol- 
lowing pages, we mean 'minims," as registered on the 
piston stem, and not drops as they are ejected from 
the end of the needle; light fluids contain several 
drops, thus counted, to the actual graduated minim. 
This is illustrated in the following medicines. Al- 
though they are not used in hypodermic medications, 
the principle is the same: 

Number of Drops in 20 Minims of these Important 
Medications. 

Acetic Acid 40 drops in 20 minims 

Hydrocyanic acid, dilute 15 

Muriatic acid 18 

Nitric acid 28 

Nitric acid, dilute 17 

Sulphuric acid 30 

Sulphuric acid, dilute 17 

Ether '. 50 

Fowler's solution 19 

Oils, essential , 40 

Tinctures 40 

Vinegars 26 

Water, distilled .: 15 

Ammonia 18 

Wine antimony 24 

Wine colchicum . . 25 

Wine opium 26 

This may be taken as a fair average, as dropped 
from a given vessel, but the drops will be found to 
vary according to the vessel from which they are 
dropped, owing to the size and contour of the flange 
or edge. 

A little study of the table above may reveal why 
one sometimes fails to get the effect expected from a 
given dose, or why one cannot get constant results from 
a given drug. 

3. Is the nut, set to regulate the number of mini- 
mums used ; these exact measurements are absolutely 
necessary in hernia and other delicate operations. 



120 . HYPODERMIC MEDICATION 

4. The cross bar should be broad and strong, so that 
continued use will not make the ringers sore. 

5. I always prefer the glass cylinder to the solid 
metal, as this style always allows you to view the con- 
tents of the liquid you are using, and gives you abso- 
lute control over the medication. 

6. Is the metal framework which supports the glass 
cylinder; this should be open on both sides. 

7. The plunger should always be provided with an 
oil cup to prevent the syringe from drying up, when not 
in use. 

8. The needle is the cutting portion of the instru- 
ment, and should always be surgically clean, and when 
not in use, a wire, previously dipped in carbolated oil, 
inserted into its caliber, which will prevent the needle 
from rusting. 

9. Is the cap which should be applied when the 
syringe is not in use. 

Before using a syringe it should always be rinsed 
out with a good antiseptic solution, followed by sterile 
water, and the needle closely watched, to avoid the ac- 
cumulation of any corrosive substance. To fill the 
syringe the needle may remain intact, but when filled 
it should be pointed upwards, and sufficient pressure 
made to expel all air. Where graduated doses of the 
solution are required, as in hernia, the set screw of the 
piston stem should be adjusted for the amount of medi- 
cated liquid required. By observing these few rules, 
hypodermic medication will never be followed with any 
disastrous results. 



LOCAL ANAESTHESIA 121 



Local Anaesthesia 



Other than averting death, the noblest calling- of the 
physician is to mitigate pain, and the reputation of the 
modern operator hinges largely upon three qualifications, 
his kind and gentle manners, his skill and his ability 
to relieve suffering, especially during surgical procedure ; 
by cultivating the former, and acquiring the technique 
of the latter, he will be amply rewarded in the prac- 
tice of his profession, for that dreadful word, 'pain," is 
despised more by suffering humanity than the money 
trust is by the Populist party. 

Modern chemistry has provided the physician with 
many valuable products for the purpose of producing 
local anaesthesia; the first and last of these discovered 
chemicals are of the greatest value, viz. : Cocaine and 
quinine and urea hydrochloride. 

COCAINE. 

When the Spanish conquerors landed upon the Peru- 
vian coast, they found that the inhabitants greatly es- 
teemed the cocoa-leaf, which they regarded with sus- 
picious awe, and ascribed to it supernatural powers; 
only the priests, nobility, and inhabitants high in sta- 
tion, were allowed to chew the sacred leaves, which are 
now represented in their national coat-of-arms, and uni- 
versally used by the populace, in much the same way 
as we use tea, coffee and tobacco. 

Niemann finally identified the alkaloid contained in 
the leaves, in the year 1859 and gave cocaine to the 
chemical world ; for nearly twenty-five years the medical 
world remained ignorant of the most remarkable prop- 
erties of this chemical to produce local anaesthesia. It 



122 LOCAL ANAESTHESIA 

was the year 1884 that Dr. Koller published the results 
of his experiments with this substance, as a local anaes- 
thetic. After this, cocaine became generally known, and 
universally used, as a local anaesthetic. One of the 
principal points of argument against the use of cocaine 
has been its toxic influence, but my experience with this 
chemical product does not coincide with the observa- 
tions and statements made by others, regarding its toxic 
effects; and I believe you will agree with me, that my 
experience has not been limited, when I state that 1 
have used cocaine to produce local anaesthesia in over 
twenty thousand operations, and only in one instance 
have I ever seen a pronounced case of cocaine poisoning. 

In the early part of my medical career I was asso- 
ciated with a dentist, and "acquired the habit," of 
extracting teeth ; this was about the time the medical 
journals were filled with discussions regarding the toxic 
effects from cocaine. I continued its use, however, 
expecting every day I might meet my "Waterloo," and 
was finally rewarded (?) in my expectations. Previous 
to this, I had seen only slight symptoms of its toxic 
effects in its continuous use for nearly three years, in 
the removal of several thousand teeth, until the case 
referred to above was presented. This gentleman was 
about 2Q years of age, six feet tall and proportionately 
built, excepting his head, which would fit about a 6% 
hat. I noticed, however, that his head was, appar- 
ently, too small for his body. He wished fourteen 
teeth extracted; I, therefore, prepared them by inject- 
ing a three per cent cocaine solution in sections of 
three teeth at each treatment, which was my usual 
method. After I had prepared the three sections, T 
noticed that the patient was becoming pallid and per- 
spiration was standing- upon his forehead, denoting col- 
lapse. I at once gave him about three ounces of 
brandy, which seemed to have a decided reaction. In 
a few minutes he left the office, like a wild man, and 
ran through the streets to his home, about a mile dis- 
tant ; when I reached the house he was lying on the 



LOCAL ANAESTHESIA 123 

couch ; his respiration was rapid, and his pulse about 
140, and he was pouring forth an incoherent vocabu- 
lary, which he must have reincarnated from the pre- 
historic Gods. I gave him hypnotics, and in a few 
hours, he regained his normal self; a few days later 
he had the balance of his teeth extracted, by the same 
method. I extracted only one toot'h at a time, 
however, and waited as long as possible between each 
operation, which terminated like other normal cases. 
He was 'made to believe that it was the brandy, and 
not the anaesthetic that was the element which affected 
him, in his former operation ; (we physicians are a 
deceptive lot). 

It was plain to see that, in this case, an idiosyncrasy 
existed, and I wished to use the same anaesthetic to 
determine, if possible, if cocaine, U'sed in moderate quan- 
tities, could be successfully used in this class of cases. 
During the second seance, one tooth was extracted at 
a time, and the time occupied was about one hour, but 
other than the patient's desire to talk freely, which 
showed there was a slight intoxication, there was no 
marked difference from any normal case. 

'I have frequently had patients evince an inclination 
to talk freely, which is one of the first symptoms of 
cocaine intoxication, and bears the same physiological 
relation to this drug as three or four good drinks of 
whiskey would to the "tippler." If we go beyond this 
stage, we increase the physiological effect, and excite 
the brain to temporary insanity, the same as we can 
induce delirium tremens by an over amount of alcohol ; 
hence, the adage that it is "the abuse and not the use" 
of a drug which makes people condemn it. After the 
above experience, I was intensely interested in ob- 
taining the truth regarding the physiological action and 
toxic effect of this drug, I therefore commenced to in- 
vestigate the reports of death caused from cocaine, and 
although I communicated with many physicians and 
dentists, where these reports were derived, I 'have never 
been able to trace a single death to cocaine. My in- 
vestigations included two cases of attempted suicide, 



124 LOCAL ANAESTHESIA 

where twenty-three and thirty-two grains had been 
taken, without producing fatal results ; also, the report 
of the late Wm. H. Hammond, made when he took 
eighteen grains, at intervals, during one hour, and sur- 
vived his experience. 

I am convinced that many of the reports regarding 
the toxic influence of cocaine are erroneous. To illus- 
trate: Broughton reported a case in which unconscious- 
ness and irregular, slow respiration, with a slow pulse, 
followed the application of three minims of a twenty 
per cent solution within the cavity of a tooth. Bet- 
tleheim records the hypodermic injection of one j sixth 
grain producing alarming symptoms. 1 have seen 
many operators condemn the drug, because the patient 
fainted ; believing it to be the effects from the cocaine ; 
it is these reports which have done much to deter the 
more extensive use of this anaesthetic. I do not wish 
to be understood as stating that this chemical will not 
produce alarming symptoms, when an idosyncrasy does 
exist; so will too much whiskey in certain cases, but as 
far as absolute danger and death is concerned, I am of 
the opinion that it will require larger doses than are 
given in ordinary cases, and may be considered a per- 
fectly safe and reliable anaesthetic, if judiciously used; 
the use of cocaine may be summarized as follows : 

It is one of the best and most active local anaes- 
thetics in our possession, and bears as important rela- 
tive value as a local anaesthetic, as morphine does as 
the leading anodyne and hypnotic ; although it has 
many rivals, cocaine still leads the list. 

It may be considered absolutely safe at all times, if 
used judiciously, and with the same precaution that 
other active principles are used. One grain may be 
considered the maximum dose, although I have used 
several times this amount without any pronounced 
physiological effects. There is no way of telling where 
an idiosyncrasy exists, but do not blame the anaesthetic 
for every case of fainting, etc., which may accompany 
any operation. Cocaine will not produce death, except 
i-n extremely large doses, and when injected in small 



LOCAL ANAESTHESIA 125 

amounts it has no peer in scope for a local anaesthetic. 
Cocaine solutions deteriorate in value with age, and 
when exposed to light and heat ; solutions should, there- 
fore, always be prepared fresh, or incorporated with 
other chemicals to preserve the solution. I always use 
cocaine in the following solutions: 

3J Cocaine hydroc'hlor 15 gr. 

Carbolic acid crystals 17 gr. 

Chloral hydrate . 5 gr. 

Atropine 1/15 gr. 

Aqua, dis., q. s 1 oz. 

The above represents, approximately, a three per 
cent solution, which is the percentage I prefer for most 
minor operations ; extracting teeth, lancing felons, etc. 

When larger surfaces are anaesthetized, I often 
dilute this one-half, for the extirpation of tumors, etc. 

Since the introduction of cocaine, as a local anaes- 
thetic, there have been many other chemicals introduced 
from time to time, for the purpose of producing local 
anaesthesia. Troipacocaine was first obtained from the 
Java Coca leaves, and was afterward made synthetically. 
The hydrochloride is reputed as being less toxic than 
cocaine, more rapid in action, but of shorter duration. 
Eaieaine -a- and Eucaine -b-, are proprietary, artificial, 
alkaloids, which are claimed to be less toxic than co- 
caine, and almost as efficient. As a local anaesthetic, 
the latter preparation is always preferred ; their prin- 
cipal advantage 'being that solutions of these chemicals 
may be boiled without decomposition, and require no 
preservatives. 

Orthoform is another patented product, which has 
no chemical relation to cocaine. It is non-toxic and 
somewhat antiseptic ; its insolubility precludes its use 
by hypodermic injection. Its local anaesthetic effect is 
best used in dusting powders to abraded surfaces, and 
internally, for ulcers and cancer of the stomach. 

Holocaine is another proprietary synthetic product, 
prepared by the interaction of phenacetin and paraphe- 



126 LOCAL ANAESTHESIA 

netidin. It is too toxic for hypodermic use, and is used 
only in operations upon the eye, where it produces com- 
plete anaesthesia, without dilating the pupil, or affect- 
ing the blood vessels. Thus we find alypin, novocain, 
stovaine, chloretone salt solution, and even as simple a 
thing as plain sterile water, advocated, from time to 
time, as local anaesthetics for all minor operations. The 
principal endeavor has 'been directed toward obtaining 
an anaesthetic of equal efficiency, but less dangerous 
than cocaine ; finally, we have presented to us quinine 
and urea hydrochloride. 

QUININE AND UREA HYDROCHLORIDE. 

In the year 1896, Dr. V. M. Griswold, of Fredonia, 
N. Y., first called attention to the value of quinine, used 
hypodermically, to produce local anaesthesia. Later, 
quinine and urea hydrochloride was used by several 
southern practitioners, as it was a very soluble salt, and 
could be used hypodermically in the treatment of ma- 
laria. It was discovered that the area or site of the in- 
jection would remain "numb," or anaesthetized, for 
sometime after the injection. No important notice was 
taken of this, however, until Dr. Henry Thibault, of 
Scotts, Ark., published an article on "A New Local 
Anaesthetic," in the Journal of the Arkansas Medical 
Society, for September, 1907. This report, naturally, 
created wide interest, and favorable comments were be- 
ing heralded from all parts of the' country. In Oct., 
1909, Hertzler, Brewster and Rogers, of Kansas City, 
Mo., published a report of their investigations regarding 
the new -anaesthesia, and found that, while the one per 
cent solution, recommended by Dr. Thibault, produced 
a perfect local anaesthesia of longer duration than co- 
caine, disturbances of skin union were frequently ob- 
served, but there was no pus formation, and the thick- 
ening appeared to be due to cellular infiltration. 

Hertzler thereupon undertook to determine experi- 
mentally the cause of the induration. Experiments per- 
formed on rabbits showed that the thickening was not 



LOCAL ANAESTHESIA 127 

due to cellular infiltration at all, as was supposed on 
clinical grounds, but was due to a pure fibrinous exu- 
date free from cells. This exudate was proved to be 
fibrin by Mallory's and Weigert's stain. The reaction 
appears, therefore, to be purely chemical in nature. The 
exudation of the fibrin begins to appear within a few 
minutes. In a general way it was determined that the 
amount of exudation depended on the strength of the 
solution used ; the attempt was made, therefore, to de- 
termine a strength of solution which would not cause 
this exudation of fibrin. With ]/ 2 per cent solution the 
exudate is less than with the 1 per cent, and with Y\ 
per cent solution only traces can be discovered. To 
what extent this fibrinous exudate is subsequently con- 
verted into fibrous tissue has not yet been definitely de- 
termined, but apparently nearly all is absorbed. 

In order to determine the subjective sensations of 
the injection and to determine the question of a pos- 
sible zone of hyperesthesia about the anesthetized zone, 
Hertzler studied the effect by injection in the skin of 
his own leg. Injections of 1 per cent, y 2 per cent, % 
per cent and 1/6 per cent solutions, and an injection of 
plain water for control, were used in each series. The 
1 per cent and J / 2 per cent solutions gave immediate 
and complete anaesthesia without a particle of pain dur- 
ing its introduction. Within a few minutes there was 
a distinct induration. With the V 2 per cent solution 
anaesthesia was not complete for a few minutes, but 
was then as complete as after the use of the stronger 
solution. The 1/6 per cent solution gave delayed ana- 
esthesia, but after a few minutes was complete. In 
neither of these weaker solutions was induration^ noted 
on palpation. The water control caused intense pain 
on injection, and the anaesthesia, at no time perfect, 
lasted only a few minutes. There was a zone of hyper- 
esthesia one or two inches in width about the area in- 
jected. Curiously enough, the hyperesthesia seemed to 
be for touch and not for pain. 

The duration of the anaesthesia in the 1 per cent and 



128 LOCAL ANAESTHESIA 

y 2 per cent solutions was perfect for four or five days, 
and sensation in the ]/ 2 per cent strength was not re- 
stored to any great extent for ten days, and in the 1 
per cent solution sensation was not completely restored 
after two weeks. At no time was there the least pain, 
though the introduction of the 1 per cent and ^ per 
cent solutions was yet marked at one and two weeks 
respectively. Quinine anaesthesia, it will be seen, can 
be used for any operation where the use of local anaes- 
thesia is indicated. It has three very decided advant- 
ages over any other local anaesthetic : 

1. It is non-toxic, and can be given in unlimited 
dosage. Brewster has used 100 grains intravenously in- 
side of six hours in a patient suffering from pernicious 
malaria. 

2. The prolonged anaesthetic effect. In many cases 
post-operative anaesthesia has lasted from four to five 
hours to as many days and longer. 

3. Where a solution containing 1 per cent or over is 
used, the hemostatic effect produced by the deposition 
of fibrinous exudate is of extreme value in preventing 
post-operative oozing. 

".The exudate being fibrin in the strict chemical 
sense, the usual natural processes of hemostasis are an- 
ticipated. The coagulum occurs, it is true, about and 
not in the vessels, and their occlusion, therefore, results 
from pressure from without. The important point, 
however, is that the effect lasts from seven to fourteen 
days, a time abundantly sufficient to allow healing by 
granulation to become well advanced. This is in marked 
contrast to the ephemeral influence of cocaine and ad- 
renalin, which act only by causing a contraction of the 
muscular walls of the blood-vessel." 

Quinine and urea hydrochloride is a double salt of 
quinine and urea, made by dissolving' quinine hydro- 
chloride in hydrochloric acid, adding pure urea, and fil- 
tering the mixture through glass wool and allowing it 
to crystalize. It is soluble in its own weight of water, 
and in alcohol, it has the action of quinine and is non- 



LQCAL ANAESTHESIA 1 2 » 

irritating when injected hypodermically, and produces 
local anaesthesia, lasting in some instances, several days,, 
depending upon the strength of the solution. 

Comparing the true therapeutic value of cocaine and 
quinine and urea hydrochloride, they may ibe summed 
up as follows : 

COCAINE. QUININE AND UREA 

.. TlJ _ • ill- 4. HYDROCHLORIDE 

1. It is soluble in water. 

2. It cannot be sterilized *• & is also ver y soluble 
when in solution, in water, 

3. Produces toxic effects, 2 ' * can be sterilized, 

when used in large 3 ' Jt . 1S * bsolutel y non " 

..,• toxic, 

quantities, t TT ' « 

j* , ,4. Has a verv pronounced 

4. Does not have any hae- hjemost atic action, 
mostatic action, unless ^ Pos £ tive an ^ st he- 
used with adrenalin, sia lasts from several 

5. Anaesthetic action is of hours to days, 

short duration, 6. The healing process is 

6. Is conducive to the rapid somewhat detained by 
healing of wounds. its action. 

In selecting, from the above, a local anaesthetic for 
surgical purposes, will depend upon the field of opera- 
tion, and the results you desire to obtain. In all cos- 
metic operations upon the face, where you wish close 
union of the skin, and rapid healing, I always prefer 
cocaine, as I believe I have been rewarded with better 
results than from any other local anaesthetic. I also 
prefer this in all dental, and oral operations ; used 
either in the foregoing formula, or combined with 
adrenalin, for its haemostatic effect. Quinine and urea 
hydrochloride is always the anaesthetic of my choice for 
the removal of tumors, other than on the face, and to an- 
aesthetize large surfaces. It is, also, preferable in many 
rectal, anal, genito-urinary, and gynecological opera- 
tions, where one of the greatest influences, other than 
its use as anaesthetic, is to obtund post operative pain,, 
until the healing process is sufficiently well advanced to 



130 



LOCAL ANAESTHESIA 



require no farther use of an anodyne. The technique 
of the use of local anaesthetics will be given when dis- 
cussing the diseases in which they are used. 




GENERAL ANAESTHESIA. 

General anaesthesia is seldom required for most of 
tlhe minor operations in an office practice ; however, we 
occasionally find cases where they wish their conscious- 
ness to drift in the waters of forgetfulness. Although 
the methods of producing general anaesthesia are well 
known by every physician. I illustrate here a little in- 
strument, that was devised for obstetrical practice, 
which has rendered me valuable service on many occa- 
sions, for lancing felons, opening abscesses, etc. In ob- 
stetrical practice it is indispensable, as the patient can 
administer her own anaesthetic, which not only acts as 
a source of amusement, to occupy her mind during the 
ordeal, but also diminishes the pain of labor. The res- 
ervoir of this instrument is provided with a small piece 
of absorbent cotton or gauze, which is saturated with 
chloroform. By placing the inhalation tubes in each 
nostril, she is allowed to inhale the anaesthetic until 



LOCAL ANAESTHESIA 131 

she, involuntarily drops the instrument. The distal 
end of the instrument is provided with a cap which, 
having two rows of perforations, by this means the 
anaesthesia can be regulated, by allowing more or less 
air, as is desired. This is an exceptionally convenient 
means of having the patient administer her own anaes- 
thesia, and no harm can be done, because she cannot 
hold the inhaler long enough at a time, to receive too 
much of the anaesthetic, and has the double advantage 
of occupying her mind and relieving pain. There are 
many cases presented in office practice, in which this 
means of producing anaesthesia is commendable. 



132 SOLIDIFIED CARBON" DIOXIDE AND LIQUID AIR 

Solidified Carbon Dioxide and 
Liquid Air 



It was during the International Congress of Der- 
matologists, in 1908, that the use of liquid air was pub- 
licly announced as a valuable agent, in the treatment of 
certain malignant and cutaneous affections ; this created 
widespread interest with the medical profession. How- 
ever, the general introduction of liquid air, for thera- 
peutic purposes, is impracticable, because it has so 
many disadvantages connected with its use and manu- 
facture. It is not a medium in great demand for com- 
mercial and industrial purposes, and it is, therefore, dif- 
ficult to obtain the product without securing special 
apparatus for its manufacture. For this reason, carbon 
dioxide snow has superseded liquid air; although there 
is some difference in their physical properties, it belongs 
to the same therapeutic family, and their analogy was 
first fully demonstrated by Drs. Dade and Whitehouse. 
The process of manufacture and supply is so simple 
with carbon dioxide, compared with liquid air, that the 
latter product has been nearly abandoned in therapeu- 
tics. 

The temperature of liquid air is, approximately, 310 
degrees F. below zero ; while carbon dioxide is only 110 
degrees F. below zero. With this great difference in 
degrees of temperature, one would naturally think their 
physical properties would be correspondingly changed, 
but such is not the case. Carbon dioxide seems to 
possess just a sufficient amount of cold to accomplish 
the results desired, and the process of freezing is suffi- 
ciently low to act as a positive destroyer of tissue, with- 
out being so rapid as to prevent an intelligent observa- 



SOLIDIFIED CARBON DIOXIDE AND LIQUID AIR 133 

tion of the progress of freezing. In fact, it has been 
found that carbon dioxide, in loose crystals, produces a 
more rapid freezing action than the solidly compressed 
carbon dioxide ice; therefore, in most cases, the solidi- 
fied carbon dioxide, or carbon dioxide ice, (as it is more 
frequently called), is often preferable to the snow or 
liquid air, as we have better control of its action. The 
two factors which determine the results to be achieved 
are the degree of pressure, and the duration of t!he ap- 
plication. 






METHOD OF FILLING THE CRAYON. 

The method of preparing solidified carbon dioxide 
for therapeutic' purposes is rather an easy matter. Car- 
bon dioxide gas is supplied, for commercial purposes, to 
all soda water counters, and may be found at almost 
any drug store, for the purpose of supplying carbon- 
ated beverages. These receptacles are furnished to the 
trade in 20 and 50-pound tanks, under a pressure of 
about 1,000 pounds to the square inch. On opening the 
tap of the cylinder, t!he liquid carbonic gas escapes, and 
evaporates so rapidly that intense cold is produced, 
which freezes the liquid into a soft snow. There have 



134 SOLIDIFIED CARBON DIOXIDE AND LIQUID AIR 

been several special apparatus devised for the purpose 
of accumulating this snow; of these, the Goosmann 
apparatus is perhaps the most popular and convenient, 
for all general use. This outfit consists of a specially 
constructed crayon, which will fit any gas cylinder. To 
fill the crayon with ice it is attached to the nipple of 
the cylinder, and as the gas escapes, the ice is formed 
and molded into suitable shapes for clinical use, (see 
accompanying illustration). 

A very simple way of preparing a stick of carbonic 
acid ice, is to roll a huckaback towel around a cylin- 
drical wooden stick, about one inch in diameter ; re- 
move the wooden stick, so as to form a cone, into which 
the ice crayon may be formed. Close one end of the 
towel cone, with a loosely fitting cork; the gas cylinder 
is placed upon the table, as illustrated above, with the 
delivery pipe pointed downward, and the foot of the 
tank raised about six inches, so as to allow the liquid 
contents to flow toward the tap. The open end of the 
towel cone is placed over the tap, and the cylinder 
valve is opened, gently; as the carbonic acid gas escapes 
and evaporates into the cone, it will pass through the 
escaping channel, and the snow will be formed in 
about thirty or forty seconds. The cylinder valve may 
be closed and the snow molded in shape for clinical use. 



TECHNIQUE OF APPLICATION. 

After securing the solidified carbon dioxide, by the 
foregoing processes, its application to diseased surfaces 
is simplicity itself. The carbon dioxide is suitably 
shaped, at the point, in the form of a pointed or blunt 
crayon, to correspond with the size of the diseased sur- 
face. In small surfaces, as warts and moles, the con- 
tact surface would be smaller than it would be for 
treating an epithelioma, one inch or more in diameter. 
The solidified carbon dioxide is applied to the disease 
by firm pressure. This was formerly done in one oper- 
ation, which lasted twenty or more seconds, but as we 
have become acquainted with the destructive influence 



SOLIDIFIED CARBON DIOXIDE AND LIQUID AIR 135 

of this element, most operators prefer shorter freezing 
periods, frequently repeated. To illustrate : if we had 
a surface, four inches in diameter, to be covered, this 
could be divided in areas, of one inch in dimension, and 
instead of attempting to treat the entire surface with 
one application, prolonged to thirty or forty seconds, we 
would treat each division of the areas about five sec- 




METHOD OF APPLICATION. 



onds; after each section had been thoroughly covered, 
we would commence at the first, and repeat the treat- 
ment, until the areas had been treated from six to 
eight times, or until the required destruction of tissue 
was completed. 

This method always allows a better observation of 
the freezing process, and the gradual development of 
the inflammatory progress, and is always the method 
to pursue in treating large areas. Small surfaces, like 
warts, and moles may be treated with one or two appli- 
cations, as desired. It is always well to cover slightly 
more than the defective area, especially in warts, moles, 
and cancerous growths. 



136 SOLIDIFIED CARBON DIOXIDE AND LIQUID AIR 

In order that we may be sure of destroying every 
remnant of the disease, when the solidified carbon diox- 
ide ice is applied to living tissue, it will be found that 
the treated area is, at first, more pliable, and in a few 
seconds, becomes firm and dense; when the crayon is 
removed, the area treated will be found depressed, 
white, and hard, showing that the freezing process has 
been complete. 

The physiological effects of the frozen area will de- 
pend upon the length of time of the exposure, which 
may result in a simple erythema from a short applica- 
tion, to necrosis from a prolonged treatment. Raw 
surfaces respond with free exudation. Upon removing 
the crayon, the surface rapidly thaws out, and returns 
to its normal state, and sets up an inflammatory reac- 
tion, which is accompanied by considerable swelling; a 
wheel and vesicle follow, usually within a short time. 
The vesicle may be opened to allow the escape of fluids; 
within a few days, the frozen surface will form into a 
crust, which should be allowed to remain until it ex- 
foliates spontaneously. Any simple dressing may be 
applied, but it is better to keep dry and exposed to the 
air. The crust will desquamate, in from ten days to 
two weeks, and the underlying surface will be found 
smooth, and of delicate pink color, which gradually, re- 
sumes nearly the normal color of the surrounding skin, 
in a short time, providing the destruction of tissue has 
not been too deep. 

The cosmetic effect of this method, as a rule, is 
superior to any other manner of treatment, when used 
as a destructive agent, and by its careful use, the re- 
sultant scar tissue is so slight as to be almost unno- 
ticeable. The treatment is nearly painless, and only 
the most nervous patients will complain of suffering 
any inconvenience at all. A slight tingling sensation 
will be felt for about ten minutes after the application ; 
this rapidly disappears, and the little pain and discom- 
fort is so slight from this treatment, compared to other 
destructive agents, that the results are more than grati- 
fying to both the patient and operator. 



SOLIDIFIED CARBON DIOXIDE AND LIQUID AIR 137 

THE THERAPEUTIC USE OF SOLIDIFIED 
CARBON DIOXIDE. 

There has not been a therapeutic agent introduced 
in medicine, within the last ten years, which has a 
broader scope of usefulness than solidified carbon diox- 
ide. 'As a destructive agent, it stands in a class alone, 
and has no equal competition, when its superior qual- 
ities are considered. Its rapidity and certainty in ac- 
tion, with the minimum amount of pain, are the three 
redeeming features, which place this agent at the high- 
est pinnacle of merit, and when we survey the field in 
which this agent is applicable, we can better appreci- 
ate its value ; there is hardly a cutaneous lesion in which 
this agent may not be used to a good advantage, while 
there are many neoplasms within the cavities of the 
body, which may be reached and removed by this ther- 
apeutic measure. It is one of the best means of treat- 
ing skin cancers, and wil laccomplish, in a few seconds, 
the same results which require several hours of contin- 
uous suffering by plaster, and other means. It is the 
treatment, par excellence, for navi, lupus, rodent, and 
tuberculous ulcers, and may be successfully used in the 
treatment of superficial and deep seated epithelioma, 
warts, moles indurated eczema, X-ray burns, pigmen- 
tary and ihypertrophic congenital deformities, papilloma, 
skin tumors, and tattoo marks. Many diseases and 
growths may be readied through the orifices of the 
body, which involve the uterus, rectum and nasal canal. 
In fact, there are many conditions, too numerous to 
mention, which will yield to this treatment. These con- 
ditions will be further discussed in the following pages: 

A SUBSTITUTE OF SOLIDIFIED CARBON 
DIOXIDE. 

Whenever we have well founded facts regarding any 
therapeutic agent, there is someone to present a sub- 
stitute ,and carbon dioxide snow has met with the same 
fate. Dr. G. Knauer, has introduced Trichloracetic 



138 SOLIDIFIED CARBON DIOXIDE AND LIQUID AIR 

acid, for superficial cauterization, as equally as efficient, 
and much less expensive, and simpler in technique than 
the carbon dioxide treatment, but great care should be 
exercised that none of the acid touches the healthy- 
skin ; it is, therefore, always best to paint a zone of col- 
lodion around the affected area. The acid should first 
be liquefied with one or more drops of water, then ap- 
plied with a glass rod, of which various sizes are kept 
on hand. . 

■ The cauterization is always very superficial, unless 
the acid is actually rubbed into the tissues. A second 
application is rarely necessary, and should be post- 
poned until the scab has fallen off. The cauterized tis- 
sue will appear white as snow, and the surrounding 
area will show only a moderate hyperemia. Vesicles 
never form, and the cauterized area will turn brown 
after several hours. After eight or ten days, the scab 
can generally be . loosened. The cosmetic results are 
excellent, and the scars appear like those after the car- 
bonic acid snow treatment, and are much sightlier than 
those after cauterization, while there is hardly any pain 
during the application. 

Trichloracetic acid is indicated wherever carbonic 
acid snow may be used; except, that the latter is more 
convenient to use, when large areas are to be cauter- 
ized. This is a most excellent means of removing 
warts, small birth-marks, etc., and its convenience in 
application should recommend it for a large class of 
conditions/ 



PAINLESS AND BLOODLESS SURGERY 139 



Painless, Bloodless, Sutureless 
and Scarless Surgery 



The above caption may appear as an exaggeration 
or perhaps a prevarication of facts regarding modern 
surgical methods ; yet these means of operating may 
be accomplished or nearly perfected by adopting the 
following procedures: 

BLOODLESS SURGERY. 

It is not only a great advantage to the surgeon, 
while operating, to cause the loss of as little blood as 
possible, for this continuous oozing of blood is a 
source of annoyance during operative procedure, but 
it is also an advantage to the patient; not that the 
loss of blood will always be great, but many patients 
would withstand operations much better if it were not 
for the sight of blood. It is, therefore, always best to 
have all operations as devoid of 'blood as possible. 
When the operative field is upon the extremities, we 
have absolute control of bleeding, by the use of an 
Esmarch Haemostatic Bandage, but when we have the 
flat surface of the balance of the body, it is a different 
proposition. We do, however, have a decided control 
of hemorrhage, on superficial surfaces, by the use of 
adrenalin solutions, of various strength ; these solu- 
tions may be incorporated with the selected local an- 
aesthetic, or used independently, as desired. The ad- 
renalin, added to ,or used in conjunction with, cocaine 
eucaine, or quinine and urea hydrochloride, adds to the 
anaesthetic value, in making the anaesthesia more pro- 
found, and also avoids the depressive effects of the 



140 PAINLESS AND BLOODLESS SURGERY 

anaesthetic, as adrenalin is a pronounced heart stimu- 
lant. My experience has convinced me that the addi- 
tion of adrenaline chloride, in the solution of 1 :l,0O0 to 
1 :2O,000, has a distinct value in all minor operative 
surgery. 

The strength of the adrenalin solution will depend 
upon the size of the surface to be operated upon ; the 
smaller the surface the stronger the solufion. As a 
rule I frequently dilute the three per cent cocaine 
solution, given in the preceding chapter, with one- 
fourth part of a 1 :1000 adrenalin solution, and the 
results are most satisfactory; however, if larger sur- 
faces are anaesthetized, I alternate the injection of 
quinine and urea hydrochloride with an adrenalin 
solution, from 1:2,000 or even 1 :5,000, and obtain equal 
results. 

SUTURELESS SURGERY. 

With a view of uniting cutaneous surfaces, to avoid 
the formation of as little cicatricial tissue as possible, 
has introduced into surgery a new method of uniting 
wounds, without the use of sutures. Every surgeon is 
familiar with the fact that the penetration and tension 
of ordinary sutures are followed by minute indentures, 
which are filled with cicatricial tissue, after the re- 
moval of the suture, and to avoid these unsightly 
stitch holes, which are often more objectionable to the 
patient than the line of incision itself, wound clips are 
used. These clips are made of solid silver, which may 
be thoroughly sterilized by boiling, and offer many 
advantages over the ordinary sutures, viz.: 

If care is exercised, they will unite wounds with 
the greatest degree of accuracy in the apposition of 
the cutaneous edges, and thus reduce the formation 
of resulting scar, since there are none of the cross 
marks made by the thread passing from one needle 
hole to another, and no perceptible trace of their con- 
tact with the skin, as they do not puncture the cuticle 
deep enough to leave a scar. They are much more 



PAINLESS AND BLOODLESS SURGERY 



141 



easily and quickly applied, as the four fangs of each 
clip will accomplish the results of two stitches in one- 
half the time it takes to use the older method. Also, 
they leave a flat surface, thus facilitating the applica- 
tion of bandages and dressings. Perfect asepsis is 
assured, since germs find no opportunity of following 
the suture tract into the depths, and therefore, there 
is no oozing around stitches, which are invariably rilled 




APPLICATION OF WOUND CLIPS. 



with cicatricial tissue after operations. The application 
of these clips is practically painless, and never requires 
an anaesthetic to close a wound. 



SCARLESS SURGERY. 

Surgeons, like all other fine mechanics, endeavor to 
have their work appear as if it were accomplished by a 
master hand ; and in manipulating the human mechan- 
ism, to unite cutaneous surfaces, has given them an 
opportunity of displaying their skill ; therefore, the 
scarless surgeon is in as great demand as the painless 
operator. 

This method of reducing scar tissue to the minimum 
is said to have originated with a Japanese surgeon. 



142 PAINLESS AND BLOODLESS SURGERY 

The usual way of incising the skin has always been at 
a right angle, but such incisions are always followed by 
a lineal scar, which is difficult to entirely obliterate ; 
but, making the incision in a slanting position (see 
illustration) at an angle of about forty-five or more 
degrees will give better contact, and although the pro- 
cess of healing is the same, the fibrous and scar tissues 
is hidden from observation. If this method is care- 
fully conducted, the resultant cicatricial tissue is re- 
duced to a minimum. This is always the method used 
upon the face, and other parts of the body, where scar 
tissue is objectionable. Of course, it is impossible to 
entirely avoid the formation of some scar tissue, but 
after reducing its formation, by this means, to the 
smallest possible amount, the balance may generally be 
obliterated, after healing, by what is known as the 



m 



1. SKIN. 2. LIGATURE. 3. LINE OF INCISION. 

blending process. This consists of pinching a fold of 
skin, containing the scar, between the thumb and 
finger until the skin is tense and rubbing the scar 
violently, almost to the point of drawing blood, with 
the forefinger of the other hand, using any suitable 
massage cream for the purpose. This keeps the skin 
somewhat irritated, and by repeating the treatment a 
number of times, the scar tissue will gradually fade 
away, although it may take several weeks or months 
to accomplish the desired results. You may also use 
Thiosinamin by Cataphoresis as described on another 
page. 

ILLUSTRATIVE CASE. 

In order that I may illustrate the success obtained 
by the foregoing methods I will cite the following case : 
Mr. H applied to me to have a lipoma removed on 



PAINLESS AND BLOODLESS SURGERY 143 

his neck, directly back of the ear. This tumor had 
been developing for about two years and had obtained 
about the size of a small hen's egg. I injected the sur- 
rounding tissue with the following solution : 

Cocaine . . . . . .'..'.......:...;..... . . ^2 gr. 

Quinine and urea hyprochiloride 2 gr. 

Adrenalin (1.1000 solution) 13 Min. 

Aqua dis q. s .2 dr. 

This solution was injected along the median line of 
the incision, and at several points around the tumor 
until the pricking of the knife would cause no pain 
The two central incisions were made at an angle of 
about 45 degrees in the same direction, leaving about 
one-half inch space of skin in the center intact, so that 
when uniting the wound there would be no superfluous 
skin. The tumor was now carefully dissected away 
without rupturing the sac and the edges of the cutane- 
ous surface placed in as close apposition as possible, 
and united with the wound clips. The operative pro- 
cedure and final results were almost perfect. The 
patient did not complain of any pain during the oper- 
ation. The adrenalin solution reduced the hemorrhage 
to the minimum. The skin healed with only a trace of 
cicatricial tissue and there was absolutely no trace of 
scar tissue where the wound clips had been applied, and 
represent surgery in what I consider its most per- 
fected form. 



144 NEOPLASTIC SURGERY 



Neoplastic Surgery 



THE USE OF PARAFFIN. 

The introduction of paraffin into the domain of 
surgery has added another term to the nomenclature 
of the science, under the name of "Neoplastic Surgery," 
which was, perhaps, to identify the use of paraffin for 
scientific purposes, and differentiate and mystify its 
purpose, from its more common use in candles and 
chewing gum. 

Paraffin has quite an extensive field of surgical use- 
fulness, and every physician should become familiar 
with the technique of manipulating this neutral sub- 
stance. 

Paraffin injections are used for two principal pur- 
poses: to make cosmetic improvements, and as a sup- 
port for functional derangements ; therefore, we find its 
use indispensable in "saddle back" nose, and to fill out 
other hollow places, to add to the contour of organs 
and expressions ; its supportive influence is used in 
hernia, insufficiency of vesicle and anal sphincters, pro- 
lapsus of the uterus, paralysis of the soft palate ; it has 
also been used to prevent ankylosis, after resection and 
filling, in brain defects, and a variety of other condi- 
tions. 

PREPARATION OF PARAFFIN. 

Paraffin was discovered by Reichenbach, in 1830, 
who derived its name from parum, too little aifinis or 
affined; because the product was not attacked in its 
cold state, by concentrated sulphuric and nitric acids. 
The product may be obtained, in large quantities, from 
the dry distillation of peat, turf, coal, etc., rich in 
hydrogen. There are a large number of products 



NEOPLASTIC SURGERY 145. 

which belong to the paraffin groups, many of wnich 
have been trade-marked, under the names of vaselin, 
cosmolin, al'bolene, etc. These are all, practically grad- 
uations of the same body in a different consistency. 
They are all absolutely non-irritants, and neutral as 
water, the alkalies and acids have no action upon them, 
and therefore, when injected into living tissues, they 
have only slight, or perhaps, no reaction with the 
tissues of the body, and only act as a bland foreign 
substance. Therefore, it is particularly adapted for 
the special purpose it is used. 

If we would study the different chemical products 
of the paraffin groups, from Hexadecane to Dimyricyl, 
we would find their melting points varying from 64 
degrees F. in the former to 2'15 degrees F. in the lat- 
ter Hard paraffin (paraffinum durum), has a melting 
point from 110 degrees F., up to 166 degrees F., and 
there is no possible way of identifying the melting point 
of any paraffin unless it is tested, and the only way 
to obtain the product at the melting point desired, for 
any purpose, is to blend the hard paraffin with the 
liquid paraffin (paraffinum liquidum), frequently called 
liquid petroleum or albolene. By combining these two r 
we may obtain any degree of consistency we may de- 
sire. The melting point required for most operations 
upon the body will vary from 107 degrees F. to 115 
degrees F., according to the resistance of the tissue r 
and several other conditions, which may be presented. 

It is, therefore, always well to have paraffin of sev- 
eral degrees of melting points on hand, for different 
operations. 

I generally have paraffin prepared at two standard 
melting points: one at 107 degrees F., and one at 115 
degrees F., and by mixing the two, in the right propor- 
tions, I can approximately determine the melting point 
I desire between the two To obtain these two melting 
points, a small piece of hard paraffin is placed in a 
vessel of water containing a thermometer ; this is very 
slowly heated, and by watching the thermometer at the 



146 



NEOPLASTIC SURGERY 



time we reach the melting point, we can determine the 
melting point of the hard paraffin, and by mixing this 
with the liquid paraffin we may obtain the exact melt- 
ing point desired. This is rather a tedious process, and 
those who do not care to spend the time to prepare 
the paraffin, may obtain the preparation from surgical 
supply houses, but I have always deemed it a good 
policy to become familiar with the "tools of our pro- 
fession," and prefer to make my own paraffin prepar- 
ations. 




PARAFFIN SYRINGE. 

The next important thing to be considered in 
paraffin operations, is a suitable syringe, "with which 
to inject and place the paraffin. There have been sev- 
eral syringes devised for this purpose, but the one illus- 
trated here, has given me the best service. Under no 
consideration attempt to use paraffin with the ordinary 
hypodermic syringe, where direct pressure upon the 
piston is required to force the paraffin through the 
needle, for such procedures are always followed by dis- 
appointment. Paraffin, in a semi-solid state, is a very 
treacherous substance to inject into subcutaneous 
tissues, as the needle will invariably become clogged 
with the solid paraffin before the contents of the bar- 



NEOPLASTIC SURGERY . 147 

rel are used, and when sufficient pressure is applied to 
force the opening through the needle, it will take a 
sudden spurt, and the contents of the syringe will be 
placed in almost any part other than where it is de- 
sired ; therefore, the special syringe with a strong screw 
piston stem, we can force the paraffin into the tissues 
as s'lowly or rapidly as is desired, and always have the 
most accurate control of the distribution of the paraffin, 
and place it at exactly the points desired. 



TECHNIQUE OF USE. 

In ninety percent of all paraffin operations the melt- 
ing point of the paraffin has been from 110' to 115 de- 
grees F. This, having been previously prepared, is 
now placed in a glass receptacle and boiled in a water 
bath for ten minutes ; the syringe has also been steril- 
ized by boiling, and the surface of the operation, and 
the hands of the operator, are prepared with the same 
care as for any other surgical procedure. 

To fill the syringe, the cap is removed, and the bar- 
rel filled -from a medicine dropper, by taking the 
paraffin from the center of the boiling solution. This 
avoids the scum and other floating particles, which are 
sure to be found upon the surface of boiling paraffin 
After filling the barrel of the syringe, the cap is screwed 
on tightly, and the needle is pointed upwards, and 
sufficient pressure made upon the piston. to force the 
paraffin through the needle. The paraffin is now en- 
cased in a hermetically sealed receptacle, and is ready 
for use at the present, or may be used several days 
afterwards, by simply placing the syringe in warm 
water, to partially melt the paraffin, so that it may be 
ejected through the needle. 

I always prefer to use paraffin when it has cooled 
to a semi-solid state, as I have always found it more 
easy to manipulate and mould when placed within the 
subcutaneous tissues ; it also avoids the danger of using 
the paraffin when too hot, and thus creating damage to 



148 NEOPLASTIC SURGERY 

the tissues, a mistake which has been made by many 
operators. "There is never a day so bright that it may 
not be marred by clouds of darkness," and this is true 
with the use of paraffin, which, if properly used, will 
give the most, excellent results ; but, if used inju- 
diciously, will be the means of doing much damage. 

It is, therefore, well to become familiar with some 
of the detrimental influences which may take place by 
the use of this preparation. 

Injections of paraffin of too high temperature may 
create inflammation which would result in sloughing; 
likewise, sloughing may be induced from infection, or 
by creating too much pressure upon a given part, and 
interfering with the blood supply by an over amount 
of the paraffin. 

Wassermann reported a sad experience of necrosis, 
due to this cause, in a case of saddle back nose, which 
was only restored by skin grafting. 

Deformities from over injections have frequently 
been reported, and it is always well to bear in mind 
that, after the injection of paraffin there is more or less 
swelling, and when the reaction subsides, it will leave 
the tissues somewhat thickened ; this should always be 
allowed for, and just sufficient paraffin used to not 
quite fill the cavity, or depression,' and the formation 
of the post operative tissue allowed for. It is, there- 
fore, better to complete the operation with another in- 
jection than to dissect the paraffin away after it has 
been placed. 

Embolus and Thrombosis are also conditions which 
may follow the injection of paraffin. While there have 
been quite a number of cases reported, the percentage 
is very low, considering the extensive use of this 
preparation, and in almost all cases, the cause was at- 
tributed to using the paraffin at a too low melting 
point 



NEOPLASTIC SURGERY 149 

DISPOSITION OF PARAFFIN. 

W'hen paraffin is injected into living tissue, the 
question naturally arises : in what way is this foreign 
substance treated, and what changes take place? There 
has been much controversy regarding this point. Ger- 
sury states: "A few hours after injection the condi- 
tions are entirely changed ; a small celled infiltration 
sets in, and the paraffin, like any foreign body, is en- 
capsulated, and new tissue fibers grow through the 
mass, so that a specimen, taken from the injected area, 
resembles an inflamed lipoma." Jakuff says: "Tne 
paraffin globules are grown through like a sponge, and 
are formed into a mestnwork." 

Morton states : "New connective tissue and new 
blood vessels permeate the mass of paraffin. The fact 
is, these physicians were, no doubt, honest in their con- 
victions, but erroneous in their conclusions, for when 
paraffin is injected into the tissues it is not left in one 
mass to be intersected later by any form of tissue, but 
the force of the syringe will cause the paraffin to follow 
the channels which offer the least resistance ; in this 
way it is dispersed in such a manner that specimens 
examined some days later gives it the appearance as 
though the paraffin has been intersected by tissue, with 
an attempt to reorganize ; but specimens removed a 
few minutes after being injected will have the same 
appearance, which proves, conclusively, that the inter- 
section takes place at once; therefore, we find the 
paraffin deposited in minute channels, and also globules, 
of greater and lesser size, where tissue has been rup- 
tured in mass and allowed such deposits. Nature takes 
care of this, as it would any inert, foreign substance ; 
but during the process of reorganizing, there is some 
inflammation, which, upon subsiding, will cause the 
tissues to hypertrophy (which should always be allowed 
for), and the greatest caution should always be exer- 
cised in injecting paraffin as stated above. It will fol- 
low the course which offers the least resistance, and 
in this way, will often start in exactly the opposite 



150 NEOPLASTIC SURGERY 

direction in which you are aiming. It is for this rea- 
son, which will require, in most instances, the services 
of a reliable assistant, to make pressure with his two 
hands upon surfaces you are trying to protect. 

There will be much said regarding the use and 
technique of manipulating paraffin, in the following 
chapters, when the details will be more fully explained, 
but the foregoing are the fundamental principles upon 
which the therapeutics of paraffin are based, and by 
carefully observing them any physician will be able 
to use this valuable agent in surgical procedures, where 
it is indicated. 



CANCERS AND TUMORS 151 



Cancers, Tumors and Morbid 
Growths 



If we would consider tumors as a specialty, in rela- 
tion to the frequency in which they are found upon 
the 'human body, we would find this field abundantly 
supplied with clinical material for the Specialist It 
has been conservatively estimated that there are, at 
least, four abnormal growths, on an average, to every 
adult person, which comes under the category of 
tumors, and it is doubtful if there is a single person 
in the world whose skin or body is entirely free from 
some blemish which does not come under the classi- 
fication of tumors, while the percentage of cancerous 
growths invades our bodies to an appalling extent. 
Authenticated statistics have proven that every eleventh 
man and every eighth woman, over forty years of age, 
is afflicted with cancer. 

Cancer is rated as the seventh of deadly diseases, 
and in England more women die from cancer than 
from consumption. It will, therefore, be seen what a 
wonderful field tumors alone offer. to the office special- 
ist who acquires a knowledge of their character and 
can successfully remove these growths by the modern 
method of treatment. 

CYSTIC TUMORS. 

Nearly all cystic tumors are circumscribed, smooth, 
movable, and of slow growth ; they are painless and 
fluctuate upon pressure. The skin is unchanged in 
color, but translucent, if superficial. Aspiration will 
determine the presence and character of fluid. Cystic 



152 CANCERS AND TUMORS 

tumors may appear upon the scalp, as in wens, or the 
mucous membrane, as in renula, or along the tendons, 
or in some natural cavity, as in ganglia. Their loca- 
tion has much to do in determining the diagnosis. Un- 
less seated in some internal organ, cystic tumors rarely 
cause any trouble, except by weight and size; if thor- 
oughly removed, as a rule, they will not return 

CLASSIFICATION AND DIAGNOSIS OF 
TUMORS. 

When a patient is afflicted with an abnormal devel- 
opment, the first thing to be determined, by the physi- 
cian, is the character of the growth, and to ascertain if 
the formation is a benign or malignant development. 
There are twenty-three well defined types of tumors, of 
which five are cysts, and the remaining eighteen are 
solid or semi-solid tumors. Six of the eighteen solid 
tumors are malignant, and classed as cancers. • The use 
of the microscope is, of course, the only accurate way 
of determining the exact nature of these growths, which 
may be developed from a single, or different, cell tissue, 
in the formation of what may be known as ''mixed 
tumors;" for instance, the lympho-sarcoma, etc., (illus^ 
trated on a following page). 

The following is the classification and character of 
cystic tumors : 

Retention Tumors are formed by the distention of 
glandular sacs or ducts, with the occlusion of the exit, 
as sebaceous and mucous cysts. The 'closure of the 
ducts, which is always the cause of the formation of 
these tumors, may be due to the pressure of inflamma- 
tory swelling, cicatrization, the inspissation, and con- 
cretion of the natural discharges at the mouth of the 
ducts. The closure of the orifice does not stop the 
secretion ; rather, the irritation increases the action, and 
a large amount of material collects. The walls consist 
at first, simply of the sac, but as the tumor increases in 
size, a firm, fibrous tissue may be added to it. 



CANCERS AND TUMORS 153 

Exudation — Tumors are formed 'by the accumula- 
tion of the contents of pre-existing, closed cavities, as 
ganglion, hydrocele, ovarian cysts, etc. The cavities, 
out of which these cysts are formed, have naturally, a 
small amount of fluid, but as the result of inflammatory 
action, a superabundance of fluid may be poured out, 
and a tumor is formed. The contents vary according 
to the natural fluid of the part, and age of the tumor, 
from a clear, colorless fluid to an almost solid sub- 
stance 

Dermoid Tumors are formed in cavities, due to arrest 
of development, and contain no excretory duct ; they are 




DERMOID TUMOR OF OVARY. SHOWING HAIR AND BONE WITH 
OPENING INTO RECTUM. 

congenital. The contents are fine hairs, embedded in 
a thick, tenaceous matter. Sometimes there is found 
bone, cartilage, teeth and other structures. 

New Formation Tumors are formed by cystic de- 
generation of the corpuscles of connective tissue ; many 
of the larger cysts of the ovary, kidney and thyroid, as 
well as cysts in tumors, are probably, formed in this 
way ; such cysts often grow with marvelous rapidity. 



154 CANCERS AND TUMORS 

Hydatid — These tumors contain an entozoon para- 
site, or vesicular worm, inclosed in a distinct, separate 
sac. The tumor resembles an ordinary cyst, except for 
the presence of the little parasite, and occurs more fre- 
quently in the liver, ovary and uterus. This tumor is 
very uncommon in America, but when it does appear, 
is very short-lived, as suppuration of the sac takes 
place, and the contents escape. If this occurs to in- 
ternal organs, it may produce death, by the excitation 
of inflammation ; usually, the sac ruptures, and the con- 
tents are discharged through some natural passage. 
When in the kidney, with the urine ; the lungs, with 
the sputa, and the liver with the faeces. 

TREATMENT OF CYSTIC TUMORS. 

The ordinary retention, dermoid, or extravasation 
cyst, is best treated by excision or enucleation. If in 
close relation with important structures, the cyst may 
be incised, the contents removed, and the surface of the 
sac thoroughly cauterized or scraped, and then left to 
heal by granulation. Exudation cysts may be treated 
in various ways ; the ganglion, by rupture or subcu- 
taneous puncture, the bursa, by puncture, and the injec- 
tion of iodine, the hydrocele, by the straight incision, 
by aspiration, or by aspiration and the injection of 
iodine. 

SOLID AND SEMI-SOLID TUMORS. 

Lipoma— This tumor is composed of fat, resembling 
normal adipose tissue, and appears to be spontaneous 
in origin in most cases, but in some, it is clearly trace- 
able to injury, irritation or pressure ; the growth is usu- 
ally slow, many years elapsing before the tumor be- 
comes especially noticeable ; may sometimes be mul- 
tiple, but do not appear simultaneously. The different 
tumors have no direct relationship to each other, being 
entirely local. They are more frequently found in the 
back and shoulders; soft and doughy, semi-elastic, and 



CANCERS AND TUMORS 155 

of uniform consistency, with a lo'bulated surface. When 
under the skin, the integument appears dimpled. This 
tumor is indolent in disposition, painless, with no en- 
largement of the subcutaneous veins. 

Fibroma — This tumor is composed of tissue resemb- 
ling normal fibrous tissue, such as forms tendons or 
ligaments, and may originate in the connective tissue 
of any part of the body, but occurs most frequently in 
the testicle, ovary, nerves, mammae, uterus, and bones 



CHONDROMA OF FINGER. 



of the upper and lower jaw. It is not peculiar to any 
age, but occurs most frequently in young adults. The 
tumor usually grows slowly, but may, eventually, attain 
a larger size ; it commences as a hard, firm nodule, de- 
veloping slowly; is painless, hard, firm, inelastic, and of 
uniform consistency. Movable, unless it springs from 
the periosteum. Its tendency is to increase, to impair 
function, and, when located in some internal organs, to 
wear out life by its secondary effects. Does not re- 
turn, if thoroughly removed. 

Chondroma — These tumors have the composition of 
tissue, resembling cartilage, and occur most frequently 
in connection with cartilage or bone. Of cartilaginous 
origin, the septum nasi and costal cartilage are most 
frequent. The femur, tibia, clavicle, humerus, bones of 
the fore-arm, phalanges, and innominate bones produce 
most of the chondroma which originates from bone. 



156 CANCERS AND TUMORS 

Young persons are more frequently attacked than adults. 
Nearly all tumors of this class commence during child- 
hood. The growth is slow, the tumor rarely attaining 
a large size. It is very prone to ossify, most frequently 
in the skeleton, as in the metacarpal or phalangeal 
bones. Firm, solid, destitute of elasticity. Circum- 
scribed, usually lobulated, or marked by irregular prom- 
inence and depressions. Painless, usually of slow 
growth, and cause inconvenience only by weight and 
pressure. May undergo cystic, fibrous, or osseous, 
transformation, ilts gravity depends upon the size and 
location. Does not return, if removed. 

Osteoma — The composition of these tumors has a 
resemblance to either hard or cancellated bone; they 
grow, almost exclusively, from the skeleton, but have 
been found in the interior of the brain, the eye, the 
lungs, and other unlooked for places. Are usually, 
found at, or about, the junction of the epiphyses with 
the diaphyses of long bones, when the increase in 
length of bone is affected, and like the chondroma, are 
most common in early life." Two varieties are found, 
the ivory and the cancellated ; the former grows, usu- 
ally, from the flat bones, and the latter from the ends 
of long bones. There may be one or more tumors; 
sometimes there is a veritable diathesis, bony tumors 
being found in every bone of the body. The growth is 
very slow, the tumor rarely attaining a large size ; their 
favorite location is the thigh bone, orbit of the eye and 
upper jaw; they are hard, immobile, and present a 
rounded, nodulated surface, with a broad base, and 
slow, painless growth ; as a rule, they do not grow to 
a large size, unless they interfere with' other organs. 

Lymphoma — This tumor has the composition of tis- 
sue, resembling that from which lymphatic glands are 
formed ; they originate in adenoid tissue, separated from 
the parent tissue by a capsule. Grow slowly and with- 
out pain. 

The number of tumors which present these charac- 
teristics is very small, microscopic investigation, almost 



CANCERS AND TUMORS 



157 



invariably, showing the presence of tubercle ; they are, 
therefore, often difficult to distinguish by appearance 
from tubercular affection of the gland. The enlarge- 
ment is in the neighborhood of lymphatic glands, but 
does not depend on tubercle or syphilis ; they are per- 
haps slow in progress, and maintain the original form 
of the gland. A pure lymphoma will cause little trou- 
ble, but the uncertainty which exists, regarding lym- 
phatic enlargement, makes the diagnosis and prognosis 
doubtful. 

Myxoma is composed of imperfectly formed mucous 
tissue, and develops in the subcutaneous tissues; in the 




MYELOID TUMOR OF RADIUS. 



nose, as polypi, in the salivary glands, in the intermus- 
cular tissue, and in the mucous cavities generally. Is 
found most frequently in adult life, in the shape of dis- 
tinct, separate tumors. The growth is usually slow, 
and the vitality low; the diagnosis is often difficult, be- 
fore extirpation, except when it occupies a mucous 
canal. The tumor is slow in developing, soft, movable, 
causes no discoloration of the skin, and does not affect 
the general health, except by the size; as a rule these 
growths are innocent, but they often exhibit malignant 
traits which will bear the closest watching. 

Myoma is a tumor composed of muscular tissue, and 
found most frequently in the uterus, kidney and pros- 
tate. As a rule, it does not develop until after the 
middle period of life. In some instances, as. in the pros- 
tate, it seems to be merely a hypertrophy of the tissue 
it occupies, while in others, as in the uterus, it may 



158 CANCERS AND TUMORS 

take the form of a polypus, or pronounced tumor. May 
occur in the oesophagus, stomach, intestines, the heart, 
the lungs, and the voluntary muscles, but its favorite 
seat is the prostate or uterus. Is tardy in growth, and 
were it not for the important organs affected, would 
cause little trouble. 

It is almost impossible, at times, to distinguish a 
myoma from a fibroma. External myomas, as a rule, 
are so rare and the treatment is the same ; the differ- 
ential diagnosis is unimportant. 

Angioma consists of a network of small blood ves- 
sels, held together by a minute quantity of alveolar tis- 
sue; this tumor is generally a malformation, having its 
origin in an abnormal dilatation of the blood-vessels ; 
occasionally, it results from injury. Is met with as a 
congenital affection, being of small size at birth, and 
then growing more or less rapidly. The ordinary loca- 
tions are the skin and mucous membranes, especially 
about the head, face, the eyelids, cheeks and tongue. 
The color varies from bright scarlet of the arterial an- 
gioma to the bluish or. purple hue of the veinous tumor. 

In the arterial form, the convolutions of the vessels 
may be easily made out through the skin ; the smallest 
pulsates regularly, and often with considerable force. 
The pulsation cannot be controlled by pressure on a 
single artery. The veinous variety is of a deeper pur- 
ple color, which has given it the name of "wine mark ;" 
this birth-mark will be more thoroughly discussed in 
another chapter, to which you are referred. 

Lymphangioma — These tumors are analogous to 
angiomas, only that they consist of a network of lym- 
phatic, instead of blood vessels. They are, also, held 
together by a minute quantity of alveolar tissue. These 
tumors are generally congenital, although they may 
appear at any period of life. They are extremely rare, 
however, and found in the vessels of the scrotum, or 
lower extremities, in union with elephantiasis. 

Neuroma — This tumor is composed, principally, of 
nerve substance, and is most frequently found on the 



CANCERS AND TUMORS 159 

ulnar, radial, median, tibial and perineal nerves. The 
exciting causes are obscure. It may, however, be traced 
to a bruise or wound. The progress is slow, and rarely 
attains a large size. These tumors are very sensitive 
to the touch, and are attended with sharp, darting pains, 
increased by atmospheric changes ; they do not affect 
the general health, unless very painful, and if thoroughly 
removed, will not return. 

Papilloma — These tumors are composed of papillae, 
whose structure comprises a basis or central stem of 
connective tissue, containing usually, a vessel, and a 
covering of epithelium ; they seem to be the result of 
chronic inflammation, or the irritation of long continued 
discharges. Is sometimes congenital. Occur most fre- 
quently in young persons. Develop on surfaces which 
are naturally papillary, and is merely a hypertrophy of 
the natural papillae. It may take on different forms, 
according as it arises from mucous or cutaneous sur- 
faces, or depending upon the predominance of epidermal 
or papillary growth ; they are known by their wart-like 
appearance and distinguished from superficial sarcomas, 
and true epithelomas, by slower growth, by the lack of 
induration of the skin, and the absence of ulceration. 
The only fear of warts is the possibility of their devel- 
oping into an epitheloma ; when in the bladder, or 
larnyx, the outlook is more grave. 

Adenoma — These tumors are composed of substances 
resembling a secreting gland ; they arise without any 
'assignable cause, and the method of formation is very 
similar to that of the development of the natural gland. 
They grow very slowly, and rarely attain a large size. 
They are elastic and circumscribed, and difficult to dif- 
ferentiate from fibroma, except by the use of a micro- 
scope. They are most frequently found in the breast 
and salivary glands, and if thoroughly removed, will not 
return. 



160 CANCERS AND TUMORS 

MALIGNANT TUMORS. 

CARCINOMAS CANCERS. 

While the above tumors are, as a rule, considered 
synonymous, they have been classified differently by 
different authors. I believe in the advice given by an 
old cancer specialist, who said: "Never refer to a malig- 
nant tumor as a cancer, but discuss the subject, before 
the patient, as a carcinomatous formation." The ma- 
lignancy of these growths justifies the horror of the 
name "cancer." All the following cancers are generally 
classed as carcinomas, as their development takes place 
in the epithelial cells ; there is one exception, however, 
in the sarcoma, which is composed almost entirely of 
cells that have their origin in those. of the connective 
tissues, and which are embryonic in character. The 
following classifications of cancer may render some as- 
sistance in identifying the character of malignant 
growths. 

Sarcoma — This tumor always, has its starting point 
in the connective tissues. The cell element may exist 
separately, or in conjunction, in the same tumor. They 
may be either round, spindle celled, or in large, plate- 
like forms. The cause of these formations may be 
traced to local irritation, or external injury, but more 
frequently, develops spontaneously, from some unknown 
cause, between the ages of twenty and forty; although 
they frequently develop in younger persons. The 
growth commences by one or more nodules, and de- 
velops rapidly, involving the neighboring glands, which 
become incorporated in the seat of disease ; finally, the 
tumor ulcerates, and, with the advent of ulceration, the 
pain is greatly increased and the system becomes in- 
fected, by involving the liver, lungs or other remote 
organs. The consistency of the tumor may be either 
hard or soft; depending upon the tissue it develops 
within. If in the bone, or periosteum it is hard, but in 
other parts of the body is soft and fluctuating; the 
growth is usually rapid and may attain a large size. 
Ulceration, as a rule, does not take place until late in 



CANCERS AND TUMORS 161 

the life of the disease. The subcutaneous veins are 
only slightly enlarged. The microscope shows fche com- 
position of the tumor to contain a mass of connective 
tissues, without alveolar arrangement, and unless thor- 
oughly removed, this tumor will rapidly develop, in the 
same place. 

Scirrhus — This malignant tumor, which is also 
known as "stone cancer," and "atrophying cancer," is 
composed of undeveloped epithelial tissues ; although 




LYIMPHO-SARCOMA. 



this tumor frequently follows injury, and continued 
irritation, from low forms of inflammatory processes, as 
a rule, it appears spontaneously, from unknown causes. 
It is more frequently found in the female breast than in 
any other organ, although the uterus and liver are fav- 
orite seats for this growth. It is very rare for this 
tumor to make its appearance before the fortieth year 
of age. When this tumor is found in the breast, it will 
be noted as a firm, hard, dense, nodule, under the skin, 
firmly anchored to the integument ; and, as development 
progresses, it connects adhesions to the surrounding 
parts, and becomes firmly fixed, hence the name "stone 
cancer." As the growth progresses, the pain increases. 



162 CANCERS AND TUMORS 

The integument becomes infiltrated, and livid, and con- 
tains numerous blood vessels; if in the breast, the nip- 
ple is retracted. The tumor finally ulcerates, at the 
end of about one year, and the discharge is very offen- 
sive. The neighboring lymphatic glands become af- 
fected early in the disease, and the entire body involved 
in cancerous cachexias. Unless these growths are 
thoroughly removed, at an early stage of their progress, 
they result in death, in from two to four years. 

Encephaloma — This malignant growth is often re- 
ferred to as the soft cancer, rose cancer, cerebriform 
cancer, and also fungus hematodes. They contain less 
fibrous tissue, but a greater quality of epithelial cells, 
than the scirrhus. These growths will appear at any 
age of life, and are almost the only form of cancer, oc- 
curring in childhood. This cancer will attack any part 
of the body, but is more frequently found in the breast, 
liver, uterus, testicle, eye, bones and lymphatic glands. 
These tumors are extremely vascular in structure, and 
therefore, develop rapidly, extending their destructive 
influence over a large surface, in a comparatively short 
time. They commence by a single nodule, or several 
nodules may develop at the same time. They are usu- 
ally soft, and fluctuating, easily compressed, and infil- 
trated into the surrounding tissues which it involves. 
They grow rapidly and attain a large size. The super- 
ficial veins are enlarged, the surrounding lymphatics 
are easily involved; ulcerates readily; with their under- 
mined edges. With this event, the pain is greatly in- 
creased, which is dull and heavy in character. The 
constitutional symptoms are pronounced, and unless 
every trace of the growth is removed early in the dis- 
ease, it will terminate in death, in eight months to two 
years, by exhausting the strength of the patient or de- 
stroying some important organ. 

Epihelioma — This cancerous growth is developed 
from the squamous epithelium, and is of more frequent 
occurrence than any other form of cancer. As its prin- 
cipal field of development is upon the skin and mucous 



CANCERS AND TUMORS 



163 



membranes, or at the junctions of these tissues, it is 
often referred to as the "skin cancer," or the "tobacco 
cancer," owing to its frequency at the junctions of the 
mucous membranes and skin of the mouth. This tumor 
is also found in the cervix uteri, tongue, vagina, anus, 
penis, scrotum, and the entire surface of the face and 
scalp are favorite seats for the development of this 
growth. While the skin or mucous membranes, or the 




EPITHELIOMA OF CERVEX UTERUS. AT LEFT SPECULUM VIEW, AT 
RIGHT SECTIONAL VIEW. 



junction of these tissues is the usual commencement of 
these cancers, their extension in growth will involve 
any of the structures of the body, either bone, muscle 
or cartilage. These tumors usually develop after the 
fortieth year, and are due to continuous irritation, as by 
a pipe, or cigar, in cancers of the lip, or corrosive dis- 
charges from the uterus, etc. These ulcerations may 
start from a simple crack in the. lip, or a mole or wart 



164 CANCERS AND TUMORS 

upon the face. When these cracks, incrustations, or 
tubercles appear, with an indurated base, and do not 
yield readily to simple means of treatment, they should 
be viewed suspiciously, as cancerous formations, and 
removed at the earliest possible opportunity; other- 
wise, ulceration may begin, and extend with the prog 
ress of the disease, and lymphatic involvement occurs ; 
the natural development and growth of an epitheloma 
is not, as a rule, rapid, but a small, indolent abrasion 
may exist for months before the growth begins to 
attain a more rapid development, and with the excep- 
tion of these tumors of the tongue and uterus, many 
years may elapse before a fatal termination. 

Colloma: these malignant tumors, which are also 
often referred to as "Gelatiform cancer," resemble, 
structurally, the encephaloma, but contain, independent 
of other tissues, a large quantity of clear colloid ma- 
terial. This tumor is difficult to distinguish from other 
forms of carcinoma previous to its removal; on dissect- 
ing, the growth will reveal the gelatinous substance it 
contains. These tumors are most frequently found in 
the stomach, omentum, rectum, ovaries and bones of 
the extremities, either growing as a pronounced tumor, 
or taking on the shape of the organ in which it is 
situated, its general history is similar to that of the 
encephaloma, only it does not develop as rapidly, nor 
involve the lymphatic glands at an early period. 

Melanoma: these are another form of malignant 
growth, which resemble the encephaloma, but contains 
a large quantity of black pigment matter, and are there- 
fore, often referred to as the ''black cancer." This 
growth is most frequently found in the skin and eye, 
or may commence to develop underneath a pigmentary 
mole, and as it develops, bears every resemblance to the 
rete mucosum or colored skin ; unless thoroughly re- 
moved, will terminate in death in a short time, as will 
all other cancerous formations. 



CANCERS AND TUMORS 165 

THE FORMATION OF TUMORS. 

The forms under which tumors may appear are 
manifold, and give us no certain criterion as to their 
nature. In parenchymatous organs we either find them 
as sharply circumscribed nodules, or as infiltrations. 
In the nodular form the line between the tumor and 
the normal tissue is sharp, and we get the impression 
that the tumor grows as a solid mass, pushing before 
it and compressing the normal tissues. In the infil- 
trated form this line is not so sharp, and projections 
from the tumor seem to penetrate the normal tissue; 
by their growth the tissue between them is destroyed 
by pressure or by insufficient nutrition. In this way the 
central body of the tumor increases in size, and the 
infiltration continues to advance. Frequently numer- 
ous small nodules will be seen in the neighborhood of 
a large one. These increase in size, and finally meet 
the parent nodule, minute ones continuing to appear 
at the periphery. This is called growth by dissemina- 
tion, and is best seen in the formation of the large 
solitary tubercles of the brain. 

Tumors which are seated on the surface of organs, 
as in the skin and mucous membranes, soon project 
above the surface, and various names have been given 
to characterize the form of these projections. If the 
projection merely took the shape of a rounded eleva- 
tion, a tuberosity was spoken of. The name tubercle 
was given to the smallest of these, though this name 
was afterward used to designate growths of a fixed 
histological character. When the tumors projected 
above the surface in such a way that the summit was 
broader than the base, and hung over it like a roof, it 
was called a fungous growth, and a polypus when the 
main body of the tumor was connected with the surface 
by a small pedicle. When the tumor was formed by a 
series of projections, like the papillae of the skin, it 
was called papillary, and when these projections were 
much longer and branched it was called dendrate. 



166 



CANCERS AND TUMORS 



The accompanying illustration outlines the manner 
of the development of tumors, relative to the tissue in 
which they grow. 

We know but little about the growth of tumors. 
They have been more studied in their histology as 
completed structures than in reference to their develop- 
ment and manner of growth. 




Scheme showing Forms of Tumors, a, Infiltrated; b, nodular form; 
c, peripheral growth "by infiltration; d, by dissemination; e, tuberous form; 
f, tuberous form of military size; g, fungus; h, polypus; i, papillary and 
verrucose; and k, dendrate form. 



There are two principal opinions held as to the 
manner in which tumors grow. One is that the growth 
takes place from the tumor itself, and the cells of the 
surrounding tissue play only a passive part ; and the 
other is, that the cells in the neighborhood of the 
tumor change into cells corresponding to those of the 
tumor. This last theory has been variously modified. 
Some observers assert that the cells in the normal 
tissue, in the neighborhood of the tumor, first return 
to their indifferent or embryonic form, and then differ- 
entiate themselves into those of the tumor. Others hold 
that the change is direct without this intermediate 
process. 



CANCERS AND TUMORS 167 

THE CAUSE OF CANCER. 

If there is any one subject which has offered a rich 
and inviting field for deep study for the pathologist, it 
has been in the investigation of the cause of tumors, 
and especially the development of malignant neoplasms, 
and yet with all our present knowledge and theories, 
we are still wrapped in the shroud of darkness. How- 
ever, clinical experience has taught us that there are 
certain conditions which seem to predispose to the 
development of these growths, which we will briefly 
review. 

Investigating the location in which the greatest 
number of cancers develop, we find them located in 
organs which are subjected to irritation. 

In a record of 9118 deaths from tumors seventy eight 
per cent were seated in the uterus, stomach, mammary 
glands and intestines; of these, twenty-five per cent 
were seated in the uterus, which had been lacerated by 
childbirth. In 219 cases of the so-called tobacco cancer, 
occurring on the lip, 209 were in men, and ten in 
women. In cancer of the lip it has also been noted 
that men from the lower classes, who smoke pipes, are 
more susceptible to cancer than those who smoke 
cigars, which are less irritating to the muco-cutaneous 
surface. 

While these statistics are decidedly in favor of the 
irritation theory, on the other hand, the face' of a man 
is more subject to irritating influences than that of a 
woman, from a variety of reasons, among which may 
be considered shaving, and yet cancer of the face is 
more common in women than in men. 

In 344 cases of cancer at the Berlin Clinic, 42 were 
attributed to trauma; where special investigations were 
made, these cases were principally tumors of the female 
breast. 

Several years ago, Dr. Keim advanced the germ 
theory, as the cause of cancer, and to-day extensive 
experiments are being conducted along these lines. 
London leads the world in facilities to study cancer; 



168 CANCERS AND TUMORS 

this city has two cancer hospitals, and two research 
laboratories, with a large corps of able medical 
scientists. 

Mice are used to a large extent for experimental 
purposes. Mice, like other animals, are subject to 
cancer: on an average, one mouse in every 3500 de- 
velops cancer spontaneously, and a mouse with a cancer 
is worth five shillings in London. If bits of cancer, the 
size of a pinhead are taken from a mouse with cancer, 
and implanted under the skin of one hundred healthy 
mice, in three weeks about five of them will have can- 
cer; if grafts of cancer be taken from these five inocu- 
lated, and planted under the skin of a second hundred, 
healthy mice, in about three weeks ten of these will be 
cancerous ; and, again, if grafts be taken from these 
ten and planted in the third hundred normal mice, about 
twenty will be affected with cancer, and these experi- 
ments may continue until ninety per cent will be 
affected. Cancer has not been communicated from 
man to mice, or vice-versa, and it has not been success- 
fully proven that it can be transferred from one human 
being to another. Of course, these experiments cannot 
be conducted as recklessly in man as they can in mice, 
but they prove that the disease can be communicated in 
this way. 

Tumors have long been recognized as hereditary, 
or we might say, there often exists a family predis- 
position to these formations. Napoleon, his father, 
brothers and sisters died of cancer. In some families, 
as well as some races, cancer appears to occur more 
frequently than in others. Broca has recorded a most 
interesting case, pointing to a family predisposition to 
cancer. The mother died of cancer of the uterus, her 
four daughters died of cancer; two of cancer of the 
liver, and two of the breast. The first daughter's four 
children died of cancer, the son with cancer of the 
stomach, and the three daughters of mammary carci- 
noma. The second daughter, from the first generation, 
had five daughters and two sons; the sons were not 



CANCERS AND TUMORS 169 

affected, but the five daughters all died from carci- 
noma. Three were of the breast, and one from the 
uterus and one from the liver; all the above subjects 
lived to be thirty-five years old before cancer de- 
veloped. 

These are only a few instances, from hundreds of 
others, to prove that there is a predisposition, in certain 
families, to malignant growths. 

Benign tumors, as a rule, develop at an early age, 
but carcinoma rarely develops until after thirty-five 
years of age, and more often at a later period in life. 
This is conclusive evidence that cancer is a disease of 
middle life, or old age ; when occurring in younger 
persons, there is evidence of senile change in their skin 
and appearance. 

THE TREATMENT OF TUMORS. 

Within the last few years there has been such rapid 
progress in the therapeutics of tumors that we often 
wonder what will be the next development, in the 
scientific world, for the removal of these unwelcome 
visitors. The physiologic method of treatment has 
entered this field with a strong force of valuable acces- 
sory measures, and exercised a predominating influence 
in many cases, and the various forms of external 
growths, which were formerly looked upon as grave 
neoplasms, are now, apparently, regarded as simple 
lesions, as they are so rapidly and conveniently re- 
moved by modern therapeutics In the following pages, 
we will briefly survey the most important methods of 
treatment, which are used by the Medical Profession, 
of the present period. 

The knife always has been and, possibly, always 
will be, the first means to consider in the removal of 
tumors, as it can be used to the best advantage in the 
greatest number of cases, and, in fact, is the only 
means we have at present of reaching internal growths. 
The possibilities of surgery are so well and favorably 
known for removing benign growths of the internal 



170 CANCERS AND TUMORS 

organs, that the subject will not be discussed here, but 
surgery for the removal of malignant growths of the 
internal organs bears fruit from another harvest, and 
still it is the only means with which we have access 
to these developments. 

Pozzi has reported 204 cases of hysterectomy for 

cancer, and states complete recovery is rare ; one of his 

cases living ten years and another six years after the 
operation. 

Cullen has reported 141 cases of cancer of the cervix, 
of which only ten were living. Massey has collected 
reports from 482 cases of cervical cancer, with only 
two living. Tubingen reports 35 per cent recovering 
from cancer of the extremities, and Schmidt gives a 
report 28.32 per cent cured from cancer of the breast 
by surgical means. We therefore, find that the knife 
does not offer us as much encouragement as we wish it 
would from Master hands, even if the greatest precau- 
tions are taken to cut wide, and remove every remnant 
of the growth. While the knife will be the dependent 
means of removing internal cancer, until the discovery 
of the much sought for "panacea," which the entire 
scientific world is striving to obtain, in the form of 
some serum. The advantages tjie knife offers, in re- 
moving benign superficial tumors, is the rapidity in 
which they may be removed, and the tendency to leave 
a less resultant scar. The latter is of especial advantage 
when these growths occur on the face or other parts 
of the body, where scar tissue appears to a disadvan- 
tage. The methods of removing these tumors are fully 
discussed on another page. 

The medical caustic treatment for cancer, or better 
known as the "plaster treatment," in many localities, is 
perhaps, the second oldest and most universally adopted 
treatment for cancer in present use, and there are very 
few caustic remedies in the Materia Medica, which have 
not been used for the removal of tumors, and especially 
skin cancers. These caustic plaster treatments were 
ushered into the healing art under a cloud of darkness, 



CANCERS AND TUMORS 171 

and as a rule, their originators held their formulas a 
profound secret, which many of them are attempting to 
do today, but the "tricks" of the cancer specialists, like 
many other things in medicine, have ceased to exist, 
and are the common property of the medical profession. 
The first caustic remedy to be successfully used in 
cancer was chloride of zinc. This remedy was the secret 
which monopolized all the cancer pastes for over fifty 
years, and it is my opinion that it stands second in value 
today. As near as we can trace the history of this 
remedy, it was used in Dr. Fell's cancer salve, nearly a 
century ago ; the original formula was : 

^ Zinc Chloride 1 dr. 

Pulv. Sanguinariai radicus 1 dr. 

Amgli q.s. to form a paste. 

Apply on pieces of kid or washed leather. 

This formula has been in constant use for over one 
hundred years, in the above, or modified forms, and 
many of the older practitioners adhere to this treatment 
today. The writer's father, who was in general practice 
for fifty years, has recorded forty-eight successful cures 
by the use of chloride of zinc. 

Later, Dr. Marsden, of the London Cancer Hospital, 
introduced the paste which bears his name, and after 
his experience in treating over six thousand cases con- 
siders arsenic superior to any other known remedy, and 
his experience has been confirmed by thousands of 
others, until, today, arsenic may be recognized as the 
leading escharotic, for the treatment of cancer. 

MARSDEN'S CANCER PASTE. 

I£ Arsenious acid . . . 2 dr. 

Gum acacia 1 dr. 

Water q. s. 

Mix the arsenious acid and gum acacia, and add suffi- 
cient water to form a paste. 



172 CANCERS AND TUMORS 

The technique of removing cancers with the above 
paste, or the chloride of zinc paste, if preferred, is as 
follows: The extent of the tumor should be well out- 
lined, and always remember that this does not include 
just the surface occupied by the growth, as the can- 
cerous growth extends, at least, from one-quarter to 
one-half inch, beyond the borders. To avoid a re- 
occurrence of the growth, this should be removed en- 
masse; after bathing the surface, rubber adhesive plas- 
ter of collodion should be placed about the tumor, so 
as to protect the healthy tissues. The outer integu- 
ment may now be curretted or removed, with salicylic 
acid, as the arsenious acid does not act well upon the 
unbroken integument, and only detains the operation. 
Previous to the curretting, it is well to thoroughly ana- 
esthetize the surface, with a 'two to four percent quin- 
ine and urea hydrochloride solution; the arsenic paste 
is now spread over the tumor, and a piece of rubber 
adhesive plaster should be cut large enough to cover 
the entire surface occupied by the paste, and project 
over the borders, which protect the healthy tissues to 
which it is attached. The application is allowed to re- 
main in situ, from eighteen to thirty-six hours or lon- 
ger, until you are satisfied that the growth has been 
entirely destroyed ; during the application of the plaster, 
the patient will suffer more or less pain ; this can be 
relieved by hypodermic injections of morphine, but in 
ordinary cases, the local anaesthetic administered for the 
curretting will obtund the tissues sufficiently to prevent 
any marked degree of pain. When the plaster is re- 
moved, the tumor will present a mass of necrosed 
black tissue, and the surrounding area will be swollen 
and inflamed. If the tumor was on the face, the eyes 
may be swollen shut, and the ears and lips cedematus. 
These conditions should be explained to the patient, 
before commencing treatment, as they have a tendency 
to frighten him, if not advised beforehand. The next 
step is to remove the necrosed mass; this is done with 
a flax-seed poultice; when the slough separates and 



CANCERS AND TUMORS 173 

comes away, you should observe if all the cancerous 
tissue has been removed; if you find any remaining 
traces of the growth left, the paste should be applied 
again, to remove these remnants. If you are convinced 
that the cauterization has been complete, the lesion 
should be dressed, as any open ulcer, and allowed to 
heal. 

This, apparently, simple procedure is one of the 
most successful methods of treatment in present use, 
for the removal of cutaneous carcinoma, and the limit 
of its application will depend upon our familiarity with 
its action ; it may be used on a surface from one to 




EPITHELIOMA REMOVED WITH MARSDEN'S PASTE. 

four inches in diameter. Larger surfaces can be treated 
with two or more applications, until growths of quite a 
size are removed. 

One of the most frequent questions asked is regard- 
ing the constitutional absorption, and poisoning from 
the arsenic. This has never occurred, to my knowledge. 
Arsenic seems to possess, more than any other remedy, 
just sufficient action to excite inflammation, and destroy 
the diseased tissue, without doing any permanent dam- 
age to the healthy structure or organism. Caution 
should be exercised, however, when the plaster is ap- 
plied to the lips and near the eye, in order that it will 



174 CANCERS AND TUMORS 

not be swallowed or injure the delicate structures of 
the eye. 

The resulting scar from this treatment is very slight, 
and when very small surfaces are treated, they are 
hardly noticeable. 

SOLIDIFIED CARBON DIOXIDE. 

Solidified carbon dioxide offers one of the most 
practical and painless methods of treatment in present 
use, for the removal of cutaneous neoplasms, either of 
a benign or malignant type, and has the following ad- 
vantages, over any other method of treatment: In se- 
lected cases, the operator always has the action of this 
chemical under his minute control, and can regulate the 
extent of its action by its brief or prolonged pressure 
to a given surface. It is the most rapid means in our 
possession, of destroying these growths, as we can ac- 
complish the same results in a few seconds which re- 
quires hours with the plaster; it is also the least pain- 
ful and most convenient way to destroy these growths, 
and seems to possess the faculty of permitting epithel- 
ium to regenerate, and thus reduces the formation of 
scar tissue to the minimum. 

The technique for removing cutaneous neoplasms, 
whether it be a wart or mole, birth-mark or epitheloma, 
is the same. The crayon of carbon dioxide, with its con- 
tact surface brought to a point, suitable in size to com- 
ply with the surface you are treating. If it should be 
a small mole, the point of the carbon dioxide should be 
small ; if the surface occupies a larger space, the point 
of the crayon may be as large as you desire. 

The action of the carbon dioxide is to freeze the 
parts, and thus produce a dry form of gangrene, which 
nature desquamates from the healthy tissues, and leaves 
a clean, healthy under tissue in its place. 

The application of solidified carbon dioxide is very 
simple ; the crayon is pressed against the growth, which, 
almost immediately, takes on the condition of freezing, 



CANCERS AND TUMORS 175 




THE RESULTS OF CARBON DIOXIDE SNOW IN THE TREATMENT 
OF 'CANCER. 



176 • CANCERS AND TUMORS 

and turns the cancerous mass into white ice ; the crayon 
is moved about the growth, until the entire surface is 
covered. Within twenty-four hours after the freezing, 
the mass forms into a crust, and at the end of from 
ten days to three or more weeks, the crust will be forced 
off by nature's process. If the operation has been suc- 
cessful, we will find a healthy looking, underlying tis- 
sue, which from a cosmetic point of view is more beau- 
tiful than from any other means of removing these 
growths, and this is the treatment par excellence for the 
removal of all small growths, including warts, moles, 
birth-marks and small tumors of a malignant nature. 
The patient should be forewarned regarding some swell- 
ing of tissue, adjacent to the growth treated, and the 
pain is so slight, that patients will often not complain 
at all, or refer to its as a sensation of heat or cold; 
which, they are not always able to determine. 

Pr. Bernstein recently reported fourteen cases in 
the Hahnemannian Monthly, one of which is illustrated 
here, and demonstrates the value of this indispensable 
process of removing these growths. The doctor states : 
''There have been no failures in the hundreds of cases 
treated; the percentage of cures still remaining one 
hundred," which is verified by the writer's observa- 
tions. 

Finsen demonstrated before the association of Dan- 
ish physicians his first case of lupus, cured by the action 
of light. This was the beginning of a new therapy, by 
the energy of radiation, in the treatment of neoplasms ; 
this system, founded by Finsen, has also involved the 
form of energy, which is utilized in various ways, and 
includes, principally, the Finsen light, x-ray, high fre- 
quency currents, radium, etc. These elements have 
been found, by constant observers, to have their basic 
effect through their ability to destroy micro-organisms 
which cannot resist the influence of light, as can the 
healthy, normal tissue. While the Finsen light is suc- 
cessful to a certain extent, most authorities have aban- 
doned its use for the more powerful forms of radia- 



CANCERS AND TUMORS 177 

tion, and the Finsen light is almost limited, in the Lon- 
don hospitals, to the milder forms of cutaneous affec- 
tions, including lupus; the other forms of radio-therapy, 
as a rule, are utilized for the treatment of cancers 
proper. While the effects of all these agents are sim- 
ilar, in some respects, in others there is a vast differ- 
ence, which experience has taught us to differentiate 
and individualize, with specific indications for each. 
Whether cancer is due to a micro-organism or not, 
makes no difference so far as the treatment is con- 
cerned ; we do know that these radio-therapeutic meas- 
ures are capable of stimulating normal cell activity, in 
their defense against the invading cancer cells, and 
cause the latter to be absorbed, but, just how this is 
accomplished no one has been able to explain. Our 
present knowledge in the 'field of radio-therapy would 
indicate the following conclusions: 1st. The Finsen 
light exerts- its best influence in superficial cutaneous 
lesions, including lupus. 2nd. The x-ray is more effec- 
tual in the deeper seated lesions, including epitheloma. 
3rd. High frequency currents are one of the best con- 
stitutional measures to increase metabolism and nutri- 
tion, relieve pain, and check the progress of disease. 
4th. Radium, when its technique is more thoroughly 
understood, perhaps will offer us a means of reaching 
these growths in the deeply seated organs. Any one or 
all of these methods may be preceded by surgery, the 
freezing or plaster treatment, to reach the deeper struc- 
tures, and are frequently utilized to their best advant- 
age in destroying the remaining cancer cells after sur- 
gical measures. 

The fact remains that solidified carbon dioxide is 
superior to any other means of treating skin cancers 
and therefore the technique of radio-therapy will not 
be discussed here. We will however disclose some of 
the possibilities and new developments regarding ra- 
dium which promises such a bright future in the treat- 
ment of cancer. 



ITS CANCERS AND TUMORS 

THE THERAPEUTICS OF RADIUM. 

It was the year 1898 that Madam Curie who was 
assisting her husband in his laboratory in Paris, suc- 
ceeded in segregating from pitch blende an oxide of 
uranium which comes from a single mine in Bohemia. 
This substance which glows in the dark and gives off 
heat without being diminished was radium which was 
hailed throughout the scientific world of medical re- 
search, with a view of obtaining if possible, its place in 
therapeutics. Shortly before this Finsen had announced 
his investigations of light, and it was immediately 
thought that radium must bear some allied influence in 
the treatment of disease, and continued investigation 
has given this substance a distinct place in therapeutics, 
and furthermore a place which it seems probable will 
be gradually extended so as to include many conditions 
which formerly seemed beyond its scope. The investi- 
gation of radium has been confined principally to cutane- 
ous lesions and malignant growths where its action is 
specific and although allied to the x-ray, Finsen and 
others, light therapy the histological changes in the can- 
cer cells, following the application of radium rays, are 
peculiar, to themselves, the beneficial effect is appar- 
ently due to its irritating action, producing obliterative 
endarteritis and fibroid changes. 

Dr. Wickham has reported several hundred cases of 
all forms of birth-marks from port wine stains to vas- 
cular and pulsating angiomas which have been reduced 
so that the skin is almost a normal color and devoid of 
cicatricial tissue. With these cases the treatment was 
prolonged to avoid any destructive influence upon the 
skin. Many other affections of the skin also respond 
to the radium treatment. Chronic eczema, lupus, acne 
rosacea psoriasis and other cutaneous affections have 
been cured after other means have failed. 

Radium has been one of our greatest hopes as a 
means of treatment for internal tumors. Dr. Abbe was 
the first to employ this method by introducing tubes 



CANCERS AND TUMORS 179 

containing the radium salts into the center of tumors, 
by this means he has obtained excellent success, partic- 
ularly in cases of deep seated sarcoma. Here we have 
the only substance to which we have access for reach- 
ing deep seated neoplasms, our only obstacle seems to 
be a means of conveying the radium to these obscure 
areas; this has been accomplished to a certain extent 
through the orifices of the body, but the results were 
not as satisfactory as desired, for it was difficult to 
place the radium rays at the point where they would 
derive their greatest value, and to receive the greatest 
benefit from this means will require the services of a- 
surgeon, and it is hoped the near future will develop 
facts in this procedure which will startle the world. 

Drs. Aikins and Harrison, of Toronto, have recently 
reported their "observations on the therapeutic use of 
radium," in which they report several interesting cases, 
and in order that the reader may become familiar with 
the results obtained from this new and promising ther- 
apeutic agent I will append their report, quite in full ; 
as I believe such reports have a tendency to point out 
the most valuable features of any therapeutic agent. 
The doctors state 

''Of rodent ulcers we have had experience with sev- 
enteen. Without exception excellent results have been 
or are being obtained. In ten a record of previous 
treatment with pastes, X-rays, or leucodescent light, 
was admitted, but no permanent curative result had fol- 
lowed. It is hardly necessary to go into the minute 
details of all these cases. After a short application of 
the radium placque, the small ulcers have almost invar- 
iably crusted over in ten to fourteen days, and when 
this crust detached itself the skin underneath was healed 
and smooth and of a pinkish tint, which soon faded to 
the normal color of the skin. These patients should be 
seen subsequently, as in cases where a slight thicken- 
ing of the tissues remains an application of the rays 
to produce a deeper penetration without an ulcerative 
effect is desirable, in order to insure a good result. 



ISO CANCERS AND TUMORS 

Where the ulceration is more extensive, longer and 
more frequent applications are necessary. The treat- 
ment in these cases sometimes extends over several 
months, as it is necessary to feel one's way very cau- 
tiously. One such case was as follows: 

Miss G., 32, came under observation Aug. 28, 1910. 
Since birth she had had an ulcerated area in the right 
temporal region. It increased gradually as a child, and 
from the age of ten until the present she had been under 
treatment of various kinds. It has twice been excised, 
and pastes, X-rays and leucodescent light have been 
tried. It would improve, but that was all. Among 
those who have seen this case there is a difference of 
opinion as to the true condition. The early age at 
which it began would suggest a lupoid character, but 
the appearance in August suggested rather a rodent 
type. Dr. Louis Wickham saw the case after some 
radium therapy had been employed, but would not 
give a definite diagnosis. He expressed the opinion 
that it was probably of lupoid character to start with, 
but had taken on the character of the rodent ulcer. 

When first seen there was an area of scar tissue on 
the right temple the shape of an equilateral triangle of 
one inch and a half to each side. In this area, three- 
quarters of an inch behind the eye, was an ulcer three- 
eighths of an inch in diameter punched out with thick- 
ened and slightly undermined edges; The floor was 
covered with pale, unhealthy looking granulations, and 
there was a sero-purulent discharge. Behind this ulcer, 
at the lower angle of the area, was another smaller ulcer 
of similar appearance, and just at the angle of the eye 
was a small ulcer, the size of a pin's head. 

A strong placque, screened, was used several times, 
and then the patient went home. She was seen again 
at the end of September. There had been a good deal 
of surface reaction, and a crust had formed over all the 
ulcers. No further treatment was given at this time. 
At the end of October she reported again. The crust 
was still present, but was easily removed, and under- 



CANCERS AND TUMORS 181 

neath the skin was formed slightly thicker than normal 
and redder, but with absolutely no ulceration. The 
parts were radiated again, using heavier screens in order 
to get a deep action and soften up the tissues. 

It is, of course, too early to say whether this result 
will be permanent, but from other cases reported in the 
French literature we can see no reason why it should 
not be. 

The early result here points to the condition being 
one of rodent ulcer rather than lupus, as experience has 
shown that the latter do not react so readily as the 
former to the action of the radium rays. 

To show the result with the common rodent ulcer, 
the following cases may be given as examples: 

Mrs. L., presented a rodent ulcer on the left side 
of the nose of four years' duration, which had resisted 
all treatment. Within one month after a series of 
radium applications the ulcer healed, and is still so at 
the time of writing, seven months after she was first 
seen. 

Mr. 'M., showed four typical rodent ulcers on the left 
cheek and one on the skin of the upper lip. They had 
been present for two years. He was given applications 
of a placque of 500,000 activity, eight hours to each 
spot, extending over a period of two weeks. At the 
end of that time the radium crusts had formed. 

Under date of Nov. 29th, the patient writes from 
New Orleans : "It affords me much pleasure to advise 
you that all trace of the affection has vanished, not 
even the smallest trace of a scar can be seen." 

Mrs. R. had a small nodule on the left side of the 
nose. It appeared two years ago and had increased in 
size until it was three-eighths of an inch in diameter. 
It was not ulcerated. It had begun to pain a short 
time before. She had had no treatment of any kind. 
She was given a short application of a strongly active 
placque, and on presenting herself six weeks later the 
nodule had quite disappeared. 



1S2 CANCERS AXD TUMORS 

Epithelioma of the Lip. — Two cases of superficial 
epitheliomata of the lip have responded splendidly to 
treatment. Other epitheliomata have been referred on 
which prolonged treatment will have to be carried out, 
and on which we hope to report more fully later. To 
mention a few: 

Mrs. B., epithelioma of the buccal mucous mem- 
brane, which had recurred after removal. She was seen 
six weeks after treatment, and there had been no re- 
appearance ; she will, however, have to be kept under 
observation from time to time. 

Fungating Epitheliomata. — Fungating cutaneous 
epitheliomata are particularly suited for radium action, 
and various techniques can be adopted depending on 
the individual case under observation. ''Cross-fire" ac- 
tion often gives excellent results with the use of dif- 
ferent forms of filters. A preliminary curettage and 
removal of the vegetations is of help in decreasing the 
time required for cure, but is not absolutely necessary. 

T. F. T., aet., 54, presented on Oct. 29th a fungating 
mass, as large as a fifty-cent piece, below and behind 
the left ear. There had been a small ulcer for about 
five years, but latterly the growth had been very rapid. 
The growth was covered with cauliflower excrescences, 
and projected three-quarters of an inch above the sur- 
rounding skin. The edges were hard and everted, and 
the tissues about were quite hard, as though the growth 
extended to some depth. There were no enlarged 
glands to be felt. Under local anaesthetic the vegeta- 
tions were removed, and the next day radium applica- 
tions were made. These were repeated for four days, 
and then the patient returned home. He was seen 
again in three weeks, at which time all that was ob- 
served was a small, healthy ulcer, one-half inch in 
diameter. The epithelium was growing over it, and it 
looked as though it should be healed completely in an- 
other two weeks. The edges were quite soft, as were 
all the surrounding tissues. A few more applications 
were made to stimulate the healing, and he again re- 



CANCERS AND TUMORS 183 

turned home. On December 1 ;th, he reported it "prac- 
tically healed, with only a small crust to be detached." 
Sarcomata. — The case described below, together 
with one other case of cancer of the uterus, forms per- 
haps the most interesting study we have made. 

R. J. B., set. 53, in February, 1909, he noticed a lump 
at the angle of the jaw, on the right side. X-rays were 
used without any apparent effect as the mass kept in- 
creasing. In April, 1910, the tumor was removed and 
showed a small round-celled sarcoma. In June it re- 
curred. Excision was again advised, but as a facial 
paresis -had followed the first operation, the patient 
would not consider further operative procedures. He 
was therefore referred for radium treatment. 

At first, very thorough radiation was carried out 
with placques, and some decrease in the size of the 
mass could be noticed. The cross-fire method was here 
used, a placque being placed on each side of the tumor. 

The beginning of October the mass was two inches 
in diameter and elevated three-quarters of an inch above 
the level of the surrounding skin. It was quite firm 
and seemed attached to the underlying angle of the jaw. 
On Oct. 5th, an incision was made into the tumor, and 
a small silver tube containing one centigram of pure 
bromide of radium, with an activity of 2,000,000 was 
inserted deeply into its center. It was left in place 24 
hours, and the result was most remarkable. At the end 
of this time there was a cavity present, into which the 
finger could be inserted, the growth felt much softer 
and was more freely movable. From the opening thus 
made broken down necrotic tissue was discharged, and 
the size of the tumor visibly diminished. Twelve days 
after this first treatment the tube was inserted again, 
two hours daily for six days, with the placque applied 
externally to produce the cross-fire action. 

The patient then returned home and reported in one 
month. On inspection no tumor mass could be seen at 
all. On palpation two small masses, which felt like 



184 CANCERS AND TUMORS 

scar tissue, were present, one just in front of the ear, 
the other behind the angle of the jaw. 

We regard this as a most gratifying result, although 
the patient can in no sense be regarded as cured, and 
will be required to be watched from time to time. He 
would be a foolish man indeed who would make any 
such claim so soon as this, but others report cases of 
round-celled sarcoma, removed and free from recur- 
rence after five years, and we see no reason why the 
same result should not be looked for here. 

Cancer of the Uterus. — In many cases of cancer 
of the uterus radium can be of great service. Dr. 
Wickham has reported cases regarded as inoperable, 
which were so reduced as to render a later operation 
possible, while where there had been recurrence in the 
scar tissues in the vault of the vagina following oper- 
ation, radium was effectual in removing it. In all 
cases the most striking effect was the rapidity with 
which the discharge and pain ceased after a very few 
applications. 

- The condition is one that offers itself very readily 
for treatment, on account of the facility with which the 
apparatus can be applied. Radium tubes can be intro- 
duced into the body of the uterus, or radium placques 
can be applied to the cervix. We have ourselves had 
the opportunity of verifying these beneficial results in 
the following cases : 

A patient, set. 53, first noticed a bloody uterine dis- 
charge in January, 1910. She did not consult a physi- 
cian until June. The cervix was cauterized, but serious 
hemorrhage recurred, and in July she underwent an 
operation at the hands of a leading gynaecologist in To- 
ronto, when the uterus was curetted, and the cervix 
amputated. This was all that was done, as, in the sur- 
geon's opinion, the left ureter and bladder were in- 
volved, and hysterectomy would not be justified. A 
very grave prognosis was given On August 15th, in 
the vault of the vagina, and where the cervix had been 



CANCERS AND TUMORS 185 

removed, was a raw, bleeding, granular surface, about 
two inches in diameter, extending into the vaginal wall. 
The left side was more involved than the right, and in 
order to remove the growth completely, an extensive 
dissection would have been required, and probably the 
removal of the left ureter. 

The uterus was fixed on the left side, and examina- 
tion by bi-manual method caused a good deal of pain. 
The body of the uterus was not enlarged. 

In view of the extensive operation which would have 
been necessary, and the uncertainty of complete re- 
moval, radium treatment was advised. 

Treatment was accordingly instituted, and from Aug- 
ust 15th to October 7th, with two weeks' intermission, 
a strong radium placque was placed against the cervix 
for twelve hours every night. The discharge ceased 
after the first few applications. The pain disappeared, 
and the bladder condition improved. On October 7th, 
a tube containing one centigram of pure bromide of 
radium in a catheter was inserted into the uterus for 
fifteen hours. The patient then returned home. Exam- 
inations made from time to time had shown a continu- 
ous improvement and lessening of the area of ulcera- 
tion. On November 30th, she reported, and Dr. Cle- 
land again examined her and reported as follows: 

On Nov. 30th, the raw surface was reduced to an 
area about half an inch in diameter, which showed no 
tendency to bleed as formerly. The uterus was more 
movable, but still somewhat fixed on the left side. The 
patient reported herself as suffering no pain nor dis- 
comfort of any kind, and as having gained about 15 
pounds in weight. The improvement in the local con- 
dition was most marked, and an operation could now 
be undertaken with more certainty of success. But, 
owing to the improvement under the radium treatment, 
it seems advisable to continue it for some time yet. 

Exophthalmic Goitre. — Dr. Abbe was the first to 
employ radium in the treatment of this condition. This 



186 CANCERS AND TUMORS 

was effected by making incisions into the thyroid gland, 
into which radium tubes were inserted. A great de- 
crease in the size of the gland followed, with amelior- 
ation of the nervous symptoms, and this result has con- 
tinued. Dr. Wickham, of Paris, has also successfully 
treated cases by the placques, with "cross-fire." 

A case which presented itself recently has given us 
an opportunity to observe the action of radium in this 
condition. 

Mrs. M., set. 31, noticed a small lump at the root of 
the neck five years ago. Local applications were used, 
but there was no change one way or the other. One 
month ago it began to grow, particularly on the right 
side. The tumor protruded and began to cause dis- 
tress in breathing, speaking and swallowing. At the 
same time she began to feel tired, with loss of energy 
and appetite. Examination showed enlargement of the 
isthmus and right lobes of the thyroid, the tumor being 
quite hard in consistency. The circumference of the 
neck was 15' inches. The pulse rate was slightly in- 
creased. 

Applications of radium placques have been made, 
and already within three weeks there has been marked 
improvement. The tumor has decreased, so that the 
circumference of the neck is only 13 inches, and the 
pressure symptoms have quite disappeared. The im- 
provement in this short period of treatment has been so 
marked that a further decrease in the size of the thyroid 
can confidently be expected. 

Post-Operative Prophylaxis. — Dr. Wickham, in his 
latest papers, insists strongly on the association oi 
radium with surgery. He claims that in many cases 
the radium rays will turn an inoperable case into an 
operable one, and further, that after operation for ma- 
lignancy, when, no matter how extensive the dissection, 
one can never be sure of having removed all the can- 
cerous tissues, radium should be used over the scar, and 
area of operation, as a prophylactic measure to destroy 
any stray neoplastic cells. 



CANCERS AND TUMORS 187 

In three cases we have so applied the treatment, two 
being sarcomas and one a carcinoma. In the latter 
case, which affected the breast, the radical operation 
was performed, and some enlarged glands were present 
in the axilla, which on microscopical examination were 
shown to be simply inflammatory. Radium applica- 
tions were made over the line of suture, ten days after 
operation. This treatment was repeated in one month. 
Whether the treatment has had any effect, we will 
probably never be able to tell, either one way or th*> 
other, as of course surgical treatment alone is very 
often effectual in these cases. 

The other two cases were sarcomata. One was in 
a male infant, in which a round-celled sarcoma had de- 
veloped at the side of the anus. It was removed by 
surgery, but reappeared in two weeks. 

. Very thorough radiation was carried out and has 
been repeated at intervals since, with the result that 
there has been no recurrence during four months, al- 
though all who saw the case regarded it as one in 
which recurrence would probably occur, and gave a 
very grave prognosis. 

The other occurred in a man of 61, on the suggestion 
of Dr. Wickham, of Paris. He had had a spindle-celled 
sarcoma of the tissues on the right side of the neck, 
which had been removed first in May, 1908, and, owing 
to a recurrence, again in 'May, 1910. It soon recurred, 
however, and a very extensive dissection was done in 
London, England, in August, 1910. Six days after the 
operation he went to Paris, where radium applications 
were made by Dr. Wickham for a period extending over 
three weeks. As a prophylactic measure, he was ad- 
vised to have this treatment repeated at intervals, and 
in Toronto in October, 1910, was given another thor- 
ough radiation over the field of operation, and partic- 
ularly at points where the scar tissue was in excess. 
By this method we believe any sarcoma cells can at 
least be held in check, if not actually destroyed. 



188 CANCERS AND TUMORS 

From the experience we have had with this agent 
during the past few months abundant opportunity has 
been given to verify the results obtained by others in 
its therapeutic use. 

Judging from results already obtained, we feel 
that radium therapy is only in its infancy, and that the 
future will disclose other pathological conditions in 
which it can be of great service." 

THE INJECTION TREATMENT OF TUMORS. 

There have been several attempts to inject different 
medicines into the substance of tumors to change the 
character of the growth, or to transform or liquefy in- 
durated growths to a sloughing process, where it may 
be treated as a simple abscess, etc. 

In certain forms of tumors this means of treatment 
has reached a reasonable degree of perfection, while 
in others it has proven deficient in the results expected ; 
this has been particularly so regarding the aim of scien- 
tific medicine to find some serum that will kill or 
paralyze cancer tissue, without destroying the normal 
tissue in which it is embedded; it is, therefore, well 
for the physician to become familiar with the latest 
facts which have developed in these lines of treatment. 

TRYPSIN TREATMENT. 

Trypsin is one of the digestive products of the pan- 
creatic gland and plays an important part in the diges- 
tion of proteids. Dr. Beard, of Edinburgh, advanced 
the theory that this remedy would digest cancerous 
growths and convert them into a substance which can 
be absorbed and eliminated. 

Dr. Luther has presented a full discussion of the 
tryspin treatment of cancer, based upon knowledge 
gained by a visit to Beard and other workers in Great 
Britain, as well as upon some observation of his own. 
Beard's introduction of tryspin as a therapeutic agent 



CANCERS AND TUMORS 189 

in cancer is based upon embryological discoveries which 
he has made in the course of his studies of this subject. 
Instead of developing directly from an egg, the course 
of development of the embryo is extremely indirect. 
The fertilized egg undergoes karyokinetic division and 
subdivision to a limited number of mitoses depending 
upon the species. The result of this is a tissue named 
variously by Beard as phorozoon, trophoblast, larva, or 
a sexual generation. This tissue, which composes in 
reality, partly or wholly, the chorion, is endowed with 
"indefinite, unrestricted powers of growth." Digestion 
in these cells is an intracellular, acid, peptic one, as has 
been proved by Hartog. 

The final division of these trophoblastic cells results 
in a primitive germ cell which again divides and sub- 
divides to a various but definite number of mitoses, de- 
pending upon the species under observation. The 
actual number for man is not known. This division 
results in a number of primary germ cells, again the 
number depending upon the number of divisions, this 
being definitely fixed for every species. For instance, 
in the skate the primitive germ cell undergoes seven 
mitoses, resulting in 512 primary germ cells. From 
one of these primary germ cells the embryo develops. 
The remaining germ cells form the foundation for the 
succeeding generation — that is, they develop into the 
sexual glands of the growing embryo. Beard has ob- 
served these cells in various stages of migration into 
the embryo. In the earliest stages of the skate, while 
there are still three distinct layers, no germ cells are 
seen while the outlying blastoderm is crowded. As 
time advances they are found between the layers, and 
later still large numbers are seen there. The objective 
point of these migrating cells is the germinal nidus, 
and after arriving there they begin to undergo division, 
and finally, after a limited number of mitoses, develop 
into primitive ova if the organ is an ovary, or sperma- 
togenic cells if a testicle. 

After the embryo is well formed and the organs 
mapped out and functionating, the trophoblast is no 



190 CANCERS AND TUMORS 

longer of use and disappears. The cause of this disap- 
pearance is purely hypothetical, but Beard believes that 
it is due to the activity of the pancreatic secretion. Up 
to this time the cell division has been an intracellular, 
acid, peptic one, and from this time, which Beard calls 
"the critical period," the digestion becomes an alkaline, 
pancreatic one, and as a consequence these cells are 
digested and absorbed. 

This normal course is subject to variations. During 
the act of migration many of the primary germ cells 
never reach their objective point — the germinal nidus — ■ 
but, wandering between the layers of the forming 
somatic cells, are obstructed in various corners and 
crevices and forever lost. The usual fate of these 
vagrant germ cells is degeneration and absorption, but 
they may become encapsulated and remain. Should 
any of these encapsulated vagrant cells attempt to go 
through its life cycle, the result might be a monstrosity 
such as the Siamese twins ; one embryo attached to 
another; or one embryo, partly or wholly developed, 
more or less completely embedded in another well- 
formed one. So we may go down through the scale to 
the class of tumors known as embryomas, teratomas, or 
dermoid cysts, which in the ovary would be the result 
of persistent germ cells. 

In the development of a malignant tumor, either the 
embryonal stage is skipped by these developing vagrant 
cells, and in proliferating a trophoblast is formed, or 
the cell attempts to go through with its normal cycle — 
the production of an ovum which in its turn develops 
into a trophoblast; the embryo failing, there is no "crit- 
ical period" and no check put upon the "indefinite, unre- 
stricted power of growth" with which these cells are 
endowed. This is an "irresponsible trophoblast," or 
malignant tumor. 

Beard, having noticed the trophoblast gradually dis- 
appear with the development of the pancreas, decided 
that the pancreatic ferments caused this disappearance. 
If this were true, he reasoned that the pancreatic fer- 



CANCERS AND TUMORS 191 

merits would cause the disappearance of an irrespon- 
sible trophoblast or malignant tumor. The theory was 
confirmed by experimental work. The pancreatic fer- 
ment acts upon the cancer albumin and the cancer 
ferment in an antagonistic manner, as a result of which 
the tumor gradually diminishes in size and disappears 
by absorption, or is killed and converted into a benign 
fibrous mass. 

Shaw-Mackenzie had introduced the use of trypsin 
in the treatment of cancer at about the same time, but 
was led to its use in an entirely different way. 

The treatment consists in the hypodermic injection 
of a solution of trypsin daily for a period of four weeks, 
followed by the hypodermic injection of a solution of 
the diastatic ferment, amylopsin, every other day alter- 
nating with the injection of trypsin, the maximum dose 
of which is maintained. This for four weeks, followed 
by another period of four weeks or more, during which 
daily injections of amylopsin alone are given. 

The trypsin injection which the author has used is 
a sterilized glycerin extract of the freshly macerated 
pancreatic gland, and besides trypsin it contains all the 
other pancreatic ferments. The amylopsin injection is, 
he believes, freed from the other ferments. They are 
both in 60-per-cent glycerin solution and consequently 
require dilution with two volumes of water or normal 
salt solution. They are put- up in sterile glass am- 
poules, containing about 20 minims each. 

The treatment should be started with a few prelim- 
ary injections of 5 or 10 minims before the full dose 
of one ampoule is given. After this the dose may be 
gradually increased. Maguire, of London, gives two 
ampoules, or 40 minims, as the maximum dose, but 75 
minims is frequently given without bad effects. The 
dose of amylopsin should be graduated in the same way. 

The injections may be given anywhere except into 
the tumor, on account of the pain and local inflamma- 
tion produced. Probably the best place is the loose 



192 CANCERS AND TUMORS 

cellular tissue of the loin.. It should be thrown deep 
into the cellular tissue, but not into muscle. The 
greatest care should be exercised to render the syringe 
and the skin at the seat of the injection sterile. Ab- 
scesses are apt to follow failure in this respect. 
Though the author has given over five hundred injec- 
tions, not one has caused any more trouble than some 
soreness and induration, which lasts for a few days. 

Trypsin is rendered inert . by heat, consequently 
care must be taken to cool the syringe after boiling 
before the solution is drawn into the barrel. 

In addition to the hypodermic injection, stress is 
laid upon the oral administration of some pancreatic 
preparation. The local application, where possible, of 
a liquid or powdered preparation of trypsin or pan- 
creatin is also recommended where the cancer can be 
reached. This undoubtedly is useful, for it does cause 
a rapid breakdown of the mass. 

Some patients after receiving a number of injec- 
tions show toxic symptoms, which Beard attributes to 
the digestion and absorption of the cancer cells. These 
symptoms, beginning with nausea and vomiting, pain 
in the back and drowsiness, develop, but usually clear 
up promptly under injections of amylopsin, while the 
trypsin treatment is continued but the dose diminished. 
Should the trypsin be continued without amylopsin in 
these cases, high arterial tension, albuminuria, rigors 
followed by rise of temperature, and coma might 
develop. 

The trypsin treatment has been used by various ob- 
servers in different parts of the world, and of the re- 
ported patients five have been pronounced cured, though 
in not one of them has the microscope corroborated the 
clinical diagnosis. It is the concensus of opinion of 
those who have tried the treatment that it does in most 
cases cause an arrest or shrinkage of the growth; im- 
provement in the general nutrition, in which the appe- 
tite improves and the weight is maintained or increased; 
diminution or cessation of pain, and diminution in the 



CANCERS AND TUMORS 193 

discharge and fetor except in those cases in which 
sloughing- occurs. Large doses are required, and per- 
fection of the treatment will necessitate the finding of 
methods for obtaining pure and more concentrated so- 
lutions of the ferments so that they can be adminis- 
tered in reasonable quantities." 



MR. CALOT'S INJECTION TREATMENT FOR 
TUMORS. 

What seems to have remained undeveloped, with the 
trypsin and other treatments, has been successfully per- 
fected by Dr. Calot, of Berck, in the successful treat- 
ment of certain benign tumors, especially of the cervical 
glands. This injection treatment is not only commend- 
able for the most excellent results obtained, but also 
from the fact that it leaves little or no trace of the oper- 
ation in the form of a resultant scar, in places on the 
body where such disfigurement is most noticeable. In 
referring to the treatment of enlarged cervical glands, 
Dr. Calot remarks : 

"By what mental aberration is it that surgeons punc- 
ture cold abscesses in other parts of the body, and oper- 
ate only in suppurating glands of the neck? In truth 
ought they not to follow exactly the opposite line of 
conduct, since the question of a scar is only of impor- 
tance in respect to the face and neck?" 

No doubt the surgeon would reply that this is the 
price that .has to be paid for the cure of the adenitis, 
that the scar is the unavoidable ransom, and that san- 
guinary intervention is the sine qua non of perfect re- 
covery. 

Yes, but is that really the case? Some twenty years 
ago I used to say the same thing, with the result that I 
operated upon large numbers of enlarged glands. 

Nowadays, I say nothing of the kind ; I no longer 
hold it to be true ; indeed, I am convinced of the con- 
trary. For the last seventeen or eighteen years I have 
given up operating enlarged glands, yet I have obtained 



194 CANCERS AND TUMORS 

cures more numerous and more satisfactory, and in 
every respect, more complete than those I used to get. 

At the present time thousands of enlarged glands 
of every degree of severity have been cured in this way 
without operation, by others as well as by me. 

Now this is precisely what practitioners in general 
are insufficiently aware of, or at any rate, they too will- 
ingly lose sight of it in practice. It is therefore, incum- 
bent upon us to repeat as emphatically as may be, viz: 

1. In many cases enlarged cervical glands undergo 
spontaneous resolution, provided that they be allowed 
time, and are assisted in so doing. 

2. The other cases of enlarged glands, those which 
do not undergo resolution, will break. A softened 
gland can nowadays be cured, without scarring, by 
method of punctures and injections. 

Having instituted this comparison, what reason can 
there be not to discard sanguinary interventions for 
enlarged glands? A treatment that mutilates and 
affords no guarantee. whatever against a return, indeed 
which very often seems to pave the way to a return. 

Yes, indeed, many and many a case have we seen 
of this relapse in patients, in spite of the fact that 
they had been operated by some of the best surgeons 
in the two hemispheres. 

These patients come to Berck for the purpose of 
escaping further interventions ; the only result of the 
previous one having been to gash them, and in some 
instances, to leave them rather worse in health than 
they were before they placed themselves in the sur- 
geon's hands. 

Here is a very striking instance of the kind, (Figs. 
1 to 4) : The young man m question was operated 
upon in London, five years ago, for a slightly enlarged 
cervical gland, by one of the foremost English sur- 
geons, so that we may take it the operation was done 
skillfully and completely. All the same the mischief 
recurred. Again he was operated upon and again it 



CANCERS AND TUMORS 



195 




Fig-. 1. — Evil results of operations; 
enlarged glands operated four times 
in England and Switzerland. — Result: 
a neck frightfully slashed for life 
with a return of the adenitis much 
larger than before the first interven- 
tion (see text). 



Fig. 2. — The same — a year later- 
after treatment by dissolvent injec- 
tions (see text). Complete cure with- 
out further scarring; there only re- 
mains the previous operative scars. 




Fig. 3. — The same (right side) on 
his arrival at Berck, for he had de- 
veloped an enormous mass of glands 
on the right, following the fourth op- 
eration on the left side (see text). 



Fig. 4. — The same, seen from the 
right side, which fortunately had not 
yet been operated. — Here he is a year 
after our treatment by injections. — 
Perfect cure without scarring. 



196 CANCERS AND TUMORS 

recurred. Then the patient betook himself to Switzer- 
land where a third operation was performed, followed 
by a third recurrence; five months later a fourth oper- 
ation with a fourth recurrence. The more they oper- 
ated the more it "grew again." 

More than this, after the fourth intervention, the 
right side, previously immune, was involved in its 
turn. 

It was at this juncture that the patient came to us 
with a double tumefaction, (Figs. 1 and 3) ; a tume- 
faction so enormous and so ugly in appearance that it 
gave one the impression rather of a lymphadenoma 
than of a bacillary adenitis. 

Now pray examine this same patient a year after he 
came to Berck, (Figs. 2 and 4). I shall explain, fur- 
ther on, how we treated and cured him without opera- 
tion. All I ask you to bear in mind with regard to this 
case, (and I have plenty of others equally convincing), 
is this : that even the freest ablation of enlarged cer- 
vical glands, however accessible they may be, does not 
afford any reliable assurance of the absence of recur- 
rence, and this is a further argument in favor of our 
aphorism : "Tuberculosis is not amenable to the scalpel, 
which rarely cures, often aggravates and surely mutil- 
ates" 

Dr. Calot's injection treatment consists of two fluids, 
one of which is used to soften the glands, when he 
wishes to hasten the dissolution, and the other injec- 
tion fluid is used where the glands have already become 
soft, as is the general course of such tumors. These 
formulas are as follows: 

CREOSOTED IODOFORMIC OIL. 

I£ Olive oil . . . ~ 70 parts 

Ether 30 " 

Creosote 3 " 

Guaiacol 1 " 

Iodoform 10 " 



CANCERS AND TUMORS 197 

CAMPHORATED NAPHTHOL. 

T$ Camphorated naphthol 2 parts 

Glycerin .12 " 

The second mixture must be well shaken up for a 
minute and a half, and injected immediately, as it is 
very unstable. 

These two liquids suffice for all requirements. The 
indications for their respective use are : as a general 
rule inject the first, (oil). The second, (camphorated 
naphthol), is to be reserved for cases in which the con- 
tents of the abscess cavity comprise grumous particles, 
blocking the needle; in such case, two or three injec- 
tions of camphorated naphthol will soften and liquefy 
the grumous material, after which we return to the oily 
liquid. 

The quantity to be injected is the same for both 
liquids viz., from 2 to 12 grammes, (half to three 
drachms), according to the age of the subject, and the 
size of the abscess cavity. If we are dealing with 
quite a small abscess, of less than 20 c.c. capacity, which 
is nearly always the case here, we inject twice less 
liquid than withdrawn pus. 

Of equal importance is a suitable aspirator, the all- 
glass syringe, illustrated here, is the usual style, or the 
metal syringe, either of which can be sterilized by boil- 
ing, are the best adapted instruments. In addition to 
the above, a tube of chloride of ethyl for local anaesthe- 
sia, some tincture of iodine to sterilize the skin, and 
antiseptic dressings are all that is required. Dr. 'Calot 
gives the following technique for the operation. 

DIRECTIONS FOR THE OPERATION. 

When should the punctures be commenced? As 
soon as fluctuation is clearly perceived. In carrying 
out these operations there are two particular recom- 
mendations, viz., to proceed with the utmost cleanliness 
and only to use very fine needles; be very clean, and 
make sure that your hands as well as the skin of the 



198 CANCERS AND TUMORS 

patient, the instruments, the liquids to be injected, and 
the final dressing are aseptic. Only use very fine 
needles, instead of the customary big trocarts, not 
bigger than 1.5 millimetre external diameter, and al- 
ways pierce healthy skin at a distance of two or three 
centimetres from the abscess, so that the two orifices 
of the skin and the abscess, may be separated by a long 
oblique canal, and at each puncture pierce the skin in 
a fresh place. 

As to the number of punctures : several will be nec- 
essary, (as a rule seven or eight), because a cure is 
much more certain than with one single puncture. The 
puncture should be made at intervals of five or six 
days. After the seventh or eighth sitting, the walls of 




DR. CALOT'S SYRINGE. 



the abscess cavity are healthy, and' refreshed enough 
to allow of our devoting our attention to the apposition. 

With this object in view, at the next sitting, after 
making a final puncture without injection, pressure is 
applied to the region with crossed strips of wadding, 
(see illustration), kept in position with one or more 
crepe bandages. 

This dressing is left off on the fifteenth day. The 
suppurating gland is cured. The duration of the treat- 
ment is therefore from 6 to 8 weeks on an average. 

Please note that this complete, absolute cure is not 
the exception, but practically the rule. 



CANCERS AND TUMORS 199 

As soon as you have become fairly familiar with the 
details of this method which, although rather minute, 
presents no actual difficulty, you will find that recov- 
ery, without scarring, takes place invariably, or nearly 
so, that is to say, ninety times in every hundred, and 
this in cases when surgeons who had been consulted, 
declared an operation unavoidable. 




Fig. • 1. — How we must not punc- 
ture, because if we plunge the nee- 
dle perpendicularly to the wall, the 
passage through the tissues will be 
too short, the edges of the little 
wound remain opposite each other 
when the needle is withdrawn, thus 
opening the door by infection of 
the abscess by pus that may flow 
back. 



Fig. 2. — How to make the punc- 
ture. The puncture is to be very 
oblique' with a much longer passage 
(A). Moreover, the retraction of 
the tissues breaks up the continuity 
of the passage and converts it into 
a labyrinth. 



WHERE THE ENLARGED GLAND IS HARD. 

It has already been stated that the enlarged glands 
stand a fifty per cent better chance of undergoing re- 
sorption, if we assist matters a little. We therefore 
imbue the patient with the necessary patience and in 
the meanwhile provoke, or promote, this resorption by 



200 CANCERS AND TUMORS 

every means at our disposal ; residence in the country, 
and if possible at the seaside, a course of balneological 
or hydrotherapeutic treatment, the administration of 
drugs, known to be used in tuberculosis, X-ray, etc., 
and adding a few injections of creosoted iodoform oil, 
taking care not to overlook the aseptisation of the 
whole of the territory discharging into the affected 
glands, more particularly the toilette of the mouth and 
teeth. Under these conditions, you will very often, 
indeed most often, see these glands disappear in the 
course of a few months. 

If it does not disappear, the enlarged gland will, in 
the long run, soften, which is after all, a mode of cure. 

We will be on the lookout for this softening, in 
order to intervene at once, before the skin has had 
time to become damaged. Thereupon by punctures 
and injections, you will cure your patient without leav- 
ing any mark. 

I only recognize one really troublesome contingency 
in practice, and fortunately, this is exceptional, viz: 
cases in which the state of the enlarged gland does not 
change, and shows no tendency in one direction or the 
other, in spite of our patience ; of repeated injections 
of creosoted iodoformic oil, in which it does not undergo 
either resorption or softening, cases in which one or 
more glands remain of pebble-like hardness, suggestive 
of lymphadenoma, (while on this point you are, no 
doubt, aware that nearly all the glandular tumors of the 
neck labeled lymphadenomata are actually cases of 
tuberculous adenitis). 

Here we may appear to be thrown back upon the 
operation, that is to say, to the inevitable and lifelong 
cicatrix. Oh. why does this obstinate gland remain 
hard? Why does it not suppurate? But the gland de- 
clines to suppurate. Well, is it not possible to con- 
strain it to suppurate? Can we not oblige this obdur- 
ate gland to break? Evidently, if we can do so, we 
shall be able by puncturing it forthwith, to avoid the 
operation and the scarring. 



CANCERS AND TUMORS 



201 




Fig. 1.— An enlarged gland, still 
hard, can be softened by injecting 
a few drops of camphorated naph- 
thol into its centre. 



Fig. 2. — First case: Softened gland 
that has undergone suppuration. It 
is punctured like a cold abscess. 





Fig. '3. — If the skin be already 
damaged the puncture is made some 
distance away through healthy skin 
and nothing is injected after the 
puncture until the skin has recov- 
ered (an injection to be made daily). 



Fig. 4. — After the eighth and last 
puncture compress the region of the 
abscess in order to bring about ad- 
hesion of the walls of the cavity. 



202 CANCERS AND TUMORS 

This is the problem, (of the artificial softening of 
these local tuberculous masses), which we were the first 
to raise, to study and finally to solve. This question 
of general pathology, we may be permitted to remark, 
was not free from difficulty, because it was necessary 
to act energetically on the tuberculous gland, (since we 
had to make it pass from the solid to the liquid state), 
but also with extreme precision, in that the action had 
to be limited to the gland leaving the skin intact, with- 
out ulceration, and without visible trace. In the course 
of our researches we tried pretty well everything; the 
local application of all the so-called dissolvent agents; 
all the internal treatments recommended as likely to 
provoke the resorption of hard glands ; breaking up the 
gland with needles in order to bring about the soften- 
ing and ultimate resorption, but all these devices proved 
unavailing. 

Intraglandular injection of every possible substance, 
including tuberculine, pepsine and pancreatine, in the 
hope of dissolving or digesting the glandular paren- 
chyma, etc. 

Ultimately, what we found most satisfactory and 
most effectual, a means that realized our ideal, (the 
melting of the tuberculoma, leaving the skin intact), 
was to inject into the hard gland, or tuberculoma, from 
eight to ten drops of our "four fluid dissolvent," which 
is as follows: 

FOUR FLUID DISSOLVENT. 

]? Phenol 1 dr. 

Camphorated napthol 1 dr. 

Sulphoricinated phenol (at 20 per cent) . 1 dr. 

Essence of turpentine 1 dr. 

This is how it is used: With a hypodermic syringe, 
you inject from six to ten drops of this mixture into the 
center of the gland; after two days, five or six drops 
again. Two days later, (that is to say, four days after 
the first injection), you will find fluctuation, and you 



CANCERS AND TUMORS 203 

may puncture. The fluid withdrawn is viscid, and of a 
mahogany color. 

You are now confronted by a suppurating gland, 
which is to be treated in the manner described above; 
puncture and injections. But thenceforth, do not inject 
anything but glycerinated, camphorated naphthol, say, 
once every five or six days. In this way, you will still 
manage to achieve a cure without scarring. 

It is to be noted, as you may have surmised, that 
this softening of the gland does not take place without 
a rather sharp local and constitutional reaction, com- 
parable with that of a "hot" abscess, or rather of a 
tepid abscess, in course of formation. The patients 
must be forewarned of this reaction, which is desirable, 
and is deliberately provoked. 

For this matter the reaction is "regulatable" easily 
enough, and will subside as soon as the softening has 
taken place, especially after the first puncture. 

Should there remain some indurated points, they 
must be dealt with by fresh dissolvent injections, but 
without pushing matters to the extent of trying to get 
rid of the tiniest vestiges. These vestiges may be left, 
for they will disappear, in the long run, completely or 
nearly so, by progressive sclerosis. 

There is no difficulty when the induration only bears 
on a single gland, but if the tumor be polyglandular, as 
in the case of the big young man, ('Figs. 1 and 3), this 
large tumor must be attacked in portions, successively, 
piece by piece. 

In the particular case under consideration, the treat- 
ment of each lobe took two months, which make eight 
months for the entire treatment. You have, however, 
seen the ultimate result we obtained by our injections, 
(see figs. 2 and 4). 

This case, in itself so instructive, is also interesting 
from another point of view, as it shows it is not abso- 
lutely necessary in order to soften a hard gland to find 
in its center a focus of caseation, the initial formation 
of a cavity. 



204 CANCERS AND TUMORS 

Happily a cicatrix in the neck is vastly easier to 
prevent than it is to remove. It can always or almost 
always be avoided by the treatment which I have just 
described. This treatment no doubt demands a cer- 
tain minuteness of application, plenty of perseverance, 
it makes far greater demands on our time than the 
rapid, brilliant but bloody intervention ; yet the latter 
leaves an indelible mark while our treatment cures 
without a trace. To cure adenitis without leaving a 
mark seems to me to be well worth a little extra trou- 
ble on our part. 

EOSIN AND SELENIUM TREATMENT. 

While this book is going to press, word comes from 
Europe that Dr. Wassermann, of Berlin, and Prof. Ehr- 
lich, of Frankfort, who, for a long time have pooled 
their forces in a search for an inoculative treatment 
for cancer, have succeeded in curing this disease, in 
mice, by a series of inoculations with eosin and selen- 
ium. The full details of this treatment are at present 
unavailable, for no doubt, they have not been perfected, 
and their experiments have only been confined to mice 
tumors, which bear a close relation to the carcinoma of 
man. The most they will say, thus far, is that it is 
possible that they will come upon some help for human 
beings, in the course of their research ; and the word 
"possible" from the lips of such men as Ehrlich and 
Wassermann, comes with weighty significance, and it 
is hoped that they have developed the long-sought 
means of destroying these growths, and with that de- 
velopment, advanced another step towards the goal 
represented in the prophetic saying "the last enemy 
that shall be destroyed is death. " 

No doubt this condition, when present, is of great 
advantage, and much facilitates the complete liquefac- 
tion of the gland, under the influence of our dissolv- 
ents, but it is not altogether indispensable,- and need 



CANCERS AND TUMORS 205 

not, a priori, dissuade us from commencing the treat- 
ment. It did not exist in this case, yet complete re- 
covery was obtained. 



206 FEATURAL SURGERY. 



Cosmetic Therapeutics and 
Featural Surgery 



Under the above caption we have the latest and one 
of the most profitable of office specialties ; this specialty 
incorporates, perhaps more of the, apparently, insignifi- 
cant things in medicine than any other specialty; in 
fact, the cosmetic treatment of the body a few years 
ago, was considered a too trifling matter for the grave- 
faced physician, and this neglect on his part has had 
a serious reaction in actually forcing such patients to 
consult the "winning ways of the beauty specialists," 
who are, as a rule, absolutely devoid of any true 
knowledge of cosmetic therapeutics, other than the use 
of massage creams and manicuring the finger nails, and 
it certainly is time that the physician should awaken 
to the fact that any information or assistance he can 
give his patients will be greatly appreciated, and, in 
many instances, he will receive more praise for his skill 
in this special sphere of practice than any other. 
Always bear in mind that the face is the most con- 
spicuous part of the body, and your work is constantly 
before the eyes of the public ; select some person in 
your vicinity, who has a broken nose or birth mark, 
successfully remove or correct this blemish or deformity, 
and you will then realize the influence it will have in 
establishing an office practice in cosmetic therapeutics. 

There are thousands of dollars waiting, in every 
vicinity, which would be gratefully paid for skill in this 
special field of medicine and surgery, as the territory 
is fertile in clinical material. Visit any public place, 
and observe the people about you who have some 
blemish or deformity of the face, which should be re- 
moved or corrected, and if we figure from the simple 



FEATURAL SURGERY. 207 

mole to the more noticeable birth-marks, scars and other 
deformities, you will find that ninety per cent of the 
people are thus afflicted. 

It has always seemed to be a trait or perhaps an 
instinct in the nature of the human family to cultivate 
as perfect a degree of beauty as possible, and if we 
would visit the deepest jungles of Africa, we would find 
the Congo belle taking the same pride in endeavoring 
to outclass her sisters in beauty lines, as the strutting 
princesses of the fashionable thoroughfares of cities. 
It is a duty, however, which each individual owes him- 
self to appear at his very best, and no one except the 
afflicted can realize the disadvantage under which they 
are laboring, who possess an unsightly scar, birthmark 
or other deformities of the face. It is only in rare in- 
stances that we find people thus afflicted employed in 
public places ; their faces are so repulsive that it is often 
difficult to find employment at all. • It is, therefore, the 
physician's duty to correct and remove these disfigure- 
ments, and thus place these unfortunate people on an 
equal footing with the rest of the world. 

There is an old saying that "beauty is only skin 
deep" ; that saying is a monstrous error, for true beauty 
is heart-deep, lung deep, stomach deep and liver deep. 
In fact, to be beautiful will depend upon the healthy 
and harmonious functions of all the organs of the body, 
and often how quickly the physician can identify, by a 
bad complexion, a "lazy liver" ; inactivity of the kidneys 
by puffiness under the eyes, and constipation by a 
muddy complexion. In cultivating true beauty these 
are the things which should first occupy our attention. 
There are many different things that have a tendency 
to make people attractive, other than complexion, and 
form ; the quick wit and sparkling eye, the vivacity of 
manner, and sprightliness of carriage have a world 
to do with personal attractiveness; yet these attain- 
ments do not go hand in hand with a torpid liver, 
dyspepsia and other inharmonious conditions of the 
body. Therefore, to obtain the translucency of the 



208 FEATURAL SURGERY. 

skin that we may almost look through the outer layers, 
and observe the blood circulating in the deeper tissues, 
which gives the rosy .cheeks and lips of the ideal com- 
plexion of pink and white, the integument cannot be 
clogged with waste matter, which should be eliminated 
by other organs. We, therefore, find that cosmetic 
therapeutics not only embodies the local application 
of massage creams, to cover up defects, as is practiced 
by the "beauty specialist", but often requires eliminative 
measures to force these toxic influences, which ruin 
many complexions, through their natural channels; 
although the skin proper will necessarily require its due 
attention. 

From a theoretical standpoint, it would seem that 
no other class of diseases furnishes such favorable condi- 
tions for an easy and accurate diagnosis and treatment 
as do the diseases and cosmetic defects of the skin. 
The morbid phenomena, instead of being concealed in 
organs remote and hidden from view, are spread out 
upon the surface, and brought directly under examina- 
tion of the senses of sight and touch. They actually 
obtrude themselves upon observation, and the disfigure- 
ment they occasion is, oftentimes, the sole reason for 
consulting a physician; yet, notwithstanding these cir- 
cumstances, there is no branch in the practice of medi- 
cine so little understood by the general practitioner 
as the diseases and cosmetic defects of the skin. 

In the treatment of these diseases and defects, the 
average physician very frequently experiences uncer- 
tainty, vexation and failure ; yet in no other class of 
conditions can a physician earn better fees, or become 
the recipient of more gratitude, commendation and 
fame, than to successfully master this branch of his 
art. In order that I may revive his "forgettory" in the 
anatomy of this important organ, the skin, I have in- 
serted the accompanying diagrammatic illustration, to 
assist in a correct understanding of the integument, 
as the different structures will be frequently referred 
to in discussing the different diseases and conditions. 



FEATURAL SURGERY. 



209 




DIAGRAMMATIC SECTION OP SKIN. 
0. Corneum. 1. Lanugo Hair. 2. Lucidum. 3. Granulosum. 4. Rete 
Mucosum. 5. Papilla?. 6. Corium or True Skin. 7. Sebaceous Gland. 8. 
Blood Supply. 9, Hair Follicle. 10. Hair Bulb. 11. Fat Cells. 12. Coil or 
Sweat Glands. 13. Sub Cutis. 

There is one principal point which is always to be 
remembered in treating the skin from a cosmetic point 
of view, viz. : We can destroy and remove the four outer 
layers of the epidermis as often as zve wish, but as soon 
as our treatment interferes with the true skin, or arrests 
its development, zve are treading upon forbidden ground, 



210 FEATURAL SURGERY. 

and our treatment will accomplish just the opposite of 
what is desired in the form of cicatricial tissue and 
resultant scars. 

The face, as a rule, is always in close proximity to 
the hands during all forms of labor; it is, therefore, the 
second part of our body which is the most susceptible 
to deformities and injury from accidents. We therefore 
find broken and deformed nose cuts, wounds, burns, 
etc., appearing upon the face nearly as frequently 
as we do upon the hand. If similar accidents would 
happen to other parts of the body they would not react 
to such a disadvantage, as they would be covered from 
observation by the clothing and not be noticed. The 
face also seems to be a favorite and unfortunate seatf 
for many destructive diseases, which mutilate the in- 
tegument. Thus we find the face the ''play grounds" 
for the ravages of smallpox and acne, with their un- 
sightly pittings, while ninety per cent of all birthmarks 
are upon the face and neck, where they will appear the 
most conspicuous and repulsive, and react to a disad- 
vantage in both a social and business way. No one 
realizes this more than the unfortunate possessor, who 
is continually subjected to the embarrassing stare of 
the ignorant, and inquisitive glances from the more 
refined people they meet on the street and elsewhere. 
As a lady stated, who had a slight deformity of the 
nose, "the way people stare at me one would think I 
was some dime museum curiosity." Other patients 
have made similar statements, whose faces contained 
several moles, superfluous hair, etc. ; one of the most 
amusing cases was a young man, nineteen years old, 
who wished to have his nose reduced in size. He 
stated that ever since he could remember he had been 
called "beaky," on account of the length of his nose, 
and, judging from the size of the organ, he was legi- 
timately entitled to the name. 

We have at our disposal many methods of treat- 
ment, whereby these conditions can be painlessly and 
permanently corrected, removed and cured, without 



FEATURAL SURGERY. 211 

leaving any trace, mark or scar, to indicate their former 
existence. By giving the benefit of your skill in this 
special field of practice, you will not only receive the 
everlasting gratitude of your patients, but will be amply 
remunerated for your services. 

COSMETIC SPECIALTIES. 

Before discussing the different diseases, deformities 
and blemishes of the face, which require treatment or 
correction, we will outline some of the popular methods 
of treatment, used in this class of conditions, as they 
will be referred to from time to time in the following 
pages. 

THE ECORCHEMENT TREATMENT. 

This treatment originated at the St. Louis Hos- 
pital, Paris, where cosmetic improvements are treated 
on an equal basis with disease. Some speculative 
"Yankee physician" managed to secure the process, and 
brought it to this country, where he disposed of it 
in several cities, to beauty specialists, for several 
thousand dollars. It is estimated that, in one year, he 
made over thirty thousand dollars by the sale of these 
formulas in different cities. The French gave it the 
name "Ecorchement," but on this side of the water, it! 
is often referred to as the rejuvenating treatment, derna 
vita, desqua dermia and other coined names, bearing 
upon new life to the skin, and is the banner treatment 
in all beauty culture establishments. This treatment 
consists of two parts, one in which the outer skin is 
killed, and the other where it is sloughed off en mass. 
The following is the original formula, although it has 
many variations, without any improvement : 

FORMULA NO. 1. 

I£ Resorcin 80 parts 

Zinc Oxide 20 parts 

Salicylic acid 4 parts 

Lard 40 parts 

Olive oil 16 parts 



212 FEATURAL SURGERY. 

FORMULA NO. 2. 

B White gelatine 8 oz. 

Zinc Oxide 4 dr. 

Glycerine y 2 dr. 

Boiling water q. s. 

Great care should be exercised in compounding these 
formulas, and better results will be obtained if they 
are prepared fresh each time they are used, and do 
not attempt to substitute vaseline for lard, in the first 
formula, unless you wish to meet with failure. 

The first formula is applied to the face twice a day, 
for about four or five days, until the skin becomes 
brown, dry and commences to crack. Then the face is 
thoroughly washed with soap and water, to remove 
every particle of ointment, and after thoroughly drying 
the skin, the second application is used. 

The ingredients of formula No. 2 are placed in a 
water bath, by first adding sufficient boiling water to 
dissolve the gelatine ; then thoroughly stir in the other 
ingredients. This should be applied to the face with 
a small paint brush, and as you cover a surface, a piece 
of absorbent gauze, the size of the painted surface, 
should be immediately applied, while the gelatine is still 
hot ; this adheres firmly to the skin, after the entire 
surface has been thoroughly covered. The same pro- 
cess should be repeated again, until you have several 
thicknesses of the gelatine and gauze, and a solid mask 
is formed. 

At the end of three or four days, it will be noticed 
that this mask is breaking loose from the edges, and 
as soon as the mask becomes loose, it can be removed, 
and the face will be found very much the same color 
as a newly born baby, and is often very sensitive to 
the touch and air. The face is dressed with any good 
cold cream, and in a few days, the shade of the skin 
resumes its normal color, only we have an absolutely 
new skin, which in many instances, is marvelously 
beautiful, for the treatment has removed every mark or 
discoloration, which the old skin had accumulated in. 



FEATURAL SURGERY. 



213 



past years, and is properly named "the rejuvenating 
treatment," as it will add the youthful appearance to 
any face. This treatment has a large sphere of useful- 
ness, and owing to the large fees, (usually one hundred 
dollars), obtained for this treatment by "Beauty Doc- 
tors," it is the backbone, from a financial point of view, 
of their establishments, and they encourage its use 
whenever opportunity presents itself; for the bane of a 




USING THE ECORCHEMENT TREATMENT ON SIDE OF 
FACE TO REMOVE BLEMISH. 

woman's existence is growing old, and this is one of 
the few means we have of restoring her youthful ap- 
pearance. It is not believed that physicians will use 
this treatment for a rejuvenating purpose, but its use 
in the treatment of many diseases places it within his 
domain. This treatment is used in acne, acne rosaca, 
eczema, chloasma, smallpox pits, and many other forms 
of facial blemishes, which will be pointed out under 
their respective classifications. 



214 FEATURAL SURGERY. 

VESICANT TREATMENT. 

Another very valuable treatment in cosmetic thera- 
peutics is the Cantharides blister; I usually prefer the 
"Canthos plaster," manufactured by Johnson & John- 
son. These blisters have the same effect as the Ecorche- 
ment treatment, and occupy less time to accomplish 
the same results. The object of both treatments is to 
remove the outer cuticle, without interfering, in any 
way, with the true skin. We, therefore, find that this 
process of blistering will occupy only about four hours, 
while the former treatment requires that many days. 
Blistering is a more heroic measure, and where a large 
surface, as the entire face, is to be treated, the Ecorche- 
ment treatment is often advisable, but all small surfaces, 
up to four inches in diameter, may be successfully 
treated by this means. If it is deemed advisable to 
treat the entire face, it should be done in sections, 
according to the following technique: Apply one plas- 
ter, from two to four inches in diameter, and allow the 
blister to form. As soon as this is accomplished, draw 
off the fluid, and apply another blister; commencing at 
the edge of the already formed vesicle. These vesicles 
may be continued, until the entire face is covered, if 
desired, or required. After you have prepared the sur- 
faces, in which you wish to remove the outer integu- 
ment, the fluid is all drawn off by puncturing the under 
surfaces, but avoiding any abrasion in the loosened 
skin ; antiseptic absorbent gauze is now applied over 
the surface, and held in position, either with strips of 
adhesive plaster, or the face mask. This is allowed to 
remain until it is "desquamated by nature; if removed 
too soon the under skin is so sensitive that the patient 
will not be able to withstand the pain. The old skin 
forms a dense scab, which can be removed in a few 
days, leaving a beautiful, new, pink under skin. This 
process of scabbing is absolutely necessary to obtain 
the best results, but the face has a horrible appearance 
of one continuous scab, (see illustration), and unless 
the patient is advised beforehand, she will think her 



FEATURAL SURGERY. 



215 



face is ruined; it is, therefore, often advisable not to 
allow the patient to see her face until the treatment is 
completed. I, therefore, keep the face mask in con- 
tinuous use, until the last remnant of old skin is 
removed. 




CRUSTOSIS AS RESULT OF VESICANT TREATMENT. 



There is one, more thing I wish to point out, viz., 
wherever this treatment is applied, and the skin re- 
moved, the final effects of the treatment are so perfect, 
and the new skin so clear and beautiful, that it makes 
the old, remaining, skin look like "the breaking up of 
a hard winter"; it is, therefore, sometimes necessary to 
remove all the skin of the face and neck, with either 
this or the ecorchment treatment, to give the face a 
uniform appearance, I often follow this blistering 
process with the ecorchment or other bleaching treat- 
ments, in order to obtain a uniform complexion ; this 
and the ecorchment treatment are among the most 
highly prized "tricks" of the beauty specialists, and 
by using these methods singly, or combining the two, 



216 



FEATURAL SURGERY 



we can eradicate many blemishes which were formerly 
rather puzzling to the physician. You can ''lift" any 
ibrm of discoloration, from cholasma to the more super- 
ficial birthmarks; while it is not as pleasing to the eye 
as the ecorchment treatment, it is more rapid and posi- 
tive in action, and with due caution, no harm can be 
obtained from its use. 




APPLICATION OF ADHESIVE PLASTERS AFTER ECORCHMENT 
VESICANT AND CARBOLIC ACID TREATMENTS. 



CARBOLIC ACID TREATMENT. 

Another still more heroic measure of destroying the 
outer skin is to apply pure Carbolic Acid ; this treat- 
ment is used with a small brush, on the surface of the 
skin, and allowed to penetrate the integument, when a 
second or third coat is given. After the skin has 
become dry, the entire surface is covered with adhesive 
strips, (see illustration) ; this is allowed to remain for 
three or four days, until the outer skin sloughs, and 
suppuration takes place. The skin is allowed to remain' 
however, until nature desquamates the integument. 
This treatment is frequently resorted to in deep-seated 
smallpox pittings, and the most favorable reports have 
been obtained in many cases. Of late, I have been 



FEATURAL SURGERY. 



217 



using the rubber adhesive strips, as illustrated above, 
with the ecorchment treatment, instead of the gelatine 
compound, as it is more convenient to apply. 

THE FACE MASK. 

This is an appliance which is very much used in 
beauty culture, and consists of a thin rubber mask, 
which is supplied in three different sizes, to fit over 
the face tightly. Its principal utilization is for the 
purpose of forcing medicine, bleaching agents, etc., 
into the skin, as by direct pressure over the entire 
surface, it compels medication to be absorbed, and 
bears an important part in many treatments, the 
technique of which will be given later. 




THE FACE MASK IN POSITION. 



VIBRATORY FACIAL MASSAGE. 

Vibratory massage is a very valuable adjunct for 
the treatment of many diseases of the face, and is used 
for the purpose of creating new activity to the circula- 
tion, acne, comedones, etc. ; its stimulating effects forces 
out impacted secretions, and assists nature in many 



218 FEATURAL SURGERY. 

ways which are conducive to eliminating disease and 
restoring the florid complexion. 

FACE CREAMS. 

Face creams are extensively used by at least one- 
half of the female population of the civilized world, for 
the purpose of making the skin soft, pliable and smooth, 
and also for bleaching purposes, and to remove slight 
blemishes. Preparations known as "cold creams" are 
mixtures of solid fats, like wax, spermaceti, petrolatum, 
lanolin, etc. Such preparations receive their name from 
the ingredients they contain, either for flavoring or 
some specific purpose ; thus we may have rose cold 
cream, when flavored with ottar of roses, cucumber 
cold cream, when the juice of cucumber is used, etc. 
These creams are rapidly absorbed by the skin, and 
have much to do in preserving and beautifying the 
integument, and also protect the skin from atmospheric 
and other conditions. A good cream will be rapidly 
absorbed by the skin without having the appearance of 
oiliness. The following formula is a well-selected 
variety for different purposes: 

VANISHING CREAM. 

The above name is given this cream, because by 
rubbing the face with this mixture, it will, apparently, 
vanish without leaving the face oily. 

If Pure stearic acid 1 oz. av. 26 grs. 

Cocoa butter 77 grs. 

Sodium Carbonate 308 grs. 

Borax 77 grs. 

Glycerine 405 mins. 

Water 13 fl. oz. 252 mins. 

Mucilage of tragacanth 3 fl. oz. 183 mins. 

Alcohol 1 fl. oz. 7 mins. 

Perfume enough 

Place all the ingredients, except the alcohol and per- 
fume, in a capsule, over a water bath, and heat until 



FEATURAL SURGERY. 219 

effervescence ceases. Remove the mixture from the 
heat, and when it begins to stiffen, add the alcohol 
containing the perfume, and mix well. Permit the mass 
to harden, and re-apply heat; beat up vigorously until 
fluffy and creamy, and place it in tubes. 

ALMOND COLD CREAM. 

^ Spermaceti 2 oz. 

White wax . 2 oz. 

Sweet almond oil 14 oz. 

Distilled water 7 oz. 

Powdered borax 60 gr. 

Coumarin . y 2 gr. 

Oil of bergamot 24 Min. 

Oil of rose ....*.... 6 Min. 

Oil of bitter almond 8 Min. 

Tincture of ambergris 5 Min. 

Melt the spermaceti and wax, add the oils, and in- 
corporate the other ingredients; this, and the other 
creams, may be called rose cold cream, by having the 
odor of rose predominate, and tinting a rose color by 
means of a solution of carmine. 

BLEACHING CREAMS. 

Are intended to remove discoloration of the skin, such 
as chloasma or liver spots, tan, freckles, etc., and de- 
pend upon bi-chloride of mercury for this purpose, 
which enters largely into most of the "patent" creams 
on the market, as in the following: 

MELVINA CREAM. 

^ Saxoline 265 gr. 

White wax . " 50 gr. 

Spermaceti 30 gr. 

Bismuth oxychloride 40 gr. 

Mercuric chloride y 2 gr. 

Spirit of rose (4 dr. of oil to one pint) 20 Min. 
Oil of bitter almonds % Min. 



220 FEATURAL SURGERY. 

Warm the saxoline, white wax, and spermaceti to- 
gether until melted; while cooling, incorporate the bis- 
muth oxychloride and mercuric chloride, this last pre- 
viously dissolved in a little alcohol, and when nearly 
cold, stir in the perfume. 

DISEASES OF THE COMPLEXION. 

The above caption may seem misplaced, yet it is 
under this head that all diseases having a tendency to 
interfere with the cosmetic appearance of the face may 
be discussed. We find the face a particularly favorite 
seat for a certain class of diseases, from which other 
parts of the body seem nearly immune ; thus we find 
acne, and acne rosacea, comedones, warts, moles, chlo- 
asma, freckles, milium seborrhcea, etc. are in reality 
diseases of the integument of the face and scalp. We 
will not attempt to discuss the pathology of these dis- 
eases but will point out, as near as possible, a success- 
ful means of curing these conditions. 

ACNE. 

Acne is a chronic inflammation of the sebaceous 
glands, characterized by the development of papules, 
pustules or tubercles, or a combination of all these 
lesions, which may also include comedones. When 
this condition exists in combination, it is usually termed 
acne vulgaris. The cause of acne, although appearing 
in patients with apparently robust health, has been at- 
tributed to gastro-intestinal disorders, anaemia chlorosis, 
uterine disorders, etc., and is a frequent disease of 
puberty. The treatment of acne should consist of both 
local and constitutional measures. For a continual 
treatment, the following, in tablet form, has been of 
more service to me than any other medication. Each 
tablet contains: 

If Arsenic 1-40-gr. 

Calcium sulphide Yi gr. 

Hexamethylenamine 2 gr. 

Ferrous carbonate . . . 5 gr. 

Sig. A tablet after each meal. 



FEATURAL SURGERY. 



221 



In resuming the therapeutic value of the above 
formula, we find arsenic the oldest, and one of our most 




ACNE VULGARIS. 

reliable remedies for arresting chronic eruptions of the 
skin. Calcium sulphide is the first remedy to be 
thought of, when pus is present, in any condition. 
Hexamethylenamine is given for its antiseptic influ- 
ence upon the gastro-intestinal tract, to arrest auto- 
intoxication, to which cause a large percent of acne is 
due. (Ferrous carbonate is added for* its blood building 
and general tonic effect. 

Constipation is present in a large percentage of 
acne cases, and a suitable treatment should be em- 
ployed, to relieve this condition at the outset of treat- 
ment. 



222 FEATURAL SURGERY. 

Local medication is also of the greatest importance, 
and sulphur, in combination with an astringent, in the 
old "stand-by" lotio alba, answers this purpose as well 
as any remedy, to my knowledge, which I have modified 
as follows : 

I£ Resorcin . . .• y 2 dr. 

Zinc sulphate 2 dr. 

Potassium sulphuret . . . j 2 dr. 

Aqua 4 oz. 

This may be made stronger or weaker as desired, as 
the different strength is required for different cases. 

Ichthyol internally, and locally, is a valuable rem- 
edy in many cases. I have also had the most brilliant 
results with the ecorchment treatment, and have fre- 
quently applied this medication to the entire afflicted 
areas, which has resulted in a rapid and complete dis- 
appearance of the acne lesions. Phototherapy is an- 
other indispensable treatment, a decided solar erythema 
should be produced, and when the outer skin is des- 
quamated, the acne will be found greatly improved. 
Electricity and vibratory massage are also valuable for 
their stimulating influence upon the skin. In all acne 
cases the greatest attention should be given to the diet, 
and every effort exercised to avoid auto-intoxication by 
keeping the bowels regular, and all the functions of the 
body in a normal condition. 

ACNE ROSACEA. 

Acne rosacea is a chronic hyperemia, or inflamma- 
tory affection, usually appearing upon the nose, cheeks 
or chin. This may appear as a simple hyperemia, or 
discoloration of the skin in the milder types, to a con- 
gestion and enlargement of the blood vessels in the pro- 
longed variety, which has been known to develop into 
a typical lipoma, as illustrated here. The cause of 
acne rosacea is the same as other forms of acne, but a 



FEATURAL SURGERY. 223 

large number of cases may be attributed to the exces- 
sive use of alcohol, (the tippler's nose), tea, coffee, etc.; 
whereby the stomach is kept in a continuous state of 
irritation. 

A red nose is generally associated with cold feet 
and hands, denoting poor circulation. This disease 
may first appear as a blood stasis in the vessels, pro- 
ducing an undue redness, which, if neglected, will cause 
the blood vessels to dilate and become hypertrophied, 
and as a result of the obstruction to circulation, the 
sebaceous glands become involved and form papules 




LIPOMA DEVELOPED FROM ACNE ROSACEA. 

and pustules. The treatment of acne rosacea has many 
things in common with other acne medications. 

Special attention should be directed to relieve con- 
stipation and keep the gastro-intestinal track aseptic 
and open. The acne tablets given above, are, in most 
cases, very serviceable. Equal parts of ichthyol and 
glycerine painted on the affected surface, at night be- 
fore going to bed, covered with oiled silk and the face 
mask. This may be thoroughly washed off in the 
morning, and lotio alba applied several times during 
the day will produce excellent results in mild cases. 



224 FEATURAL SURGERY. 

If the blood vessels are enlarged they should be 
destroyed by the electric needle, and do not forget that 
the ecorchment treatment was originally instituted for 
the purpose of curing acne rosacea, and it is often sur- 
prising the rapidity the action of this treatment has in 
many cases, while there are total failures in others. 

The solar rays may be used, as in other acae lesions, 
to a good advantage ; vibratory massage is also indis- 
pensable, to stimulate the skin to new activity. 

COMEDONES. 

This is also a chronic affection of the sebaceous 
glands, characterized by a retention, in the excretory 
ducts, of an inspissated secretion, which is visible upon 
the surface, either as white or yellow, which develops 
into black pin head elevations, hence the name "black 
heads;" this coagulated sebum may distend, and ob- 
struct the gland, until a papule or pustule is formed ; 
the duct may contain small hairs, and the microscopic 
mite demodex folliculorum, which was, at one time, 
erroneously supposed to be the cause of the disorder. 

Blackheads appear upon the face, nose, forehead, 
chin and neck. They occur exclusively in the ducts of 
the sebaceous glands — see accompanying figure, where 
SS. represents the skin ; K, the sebaceous gland with 
the duct opening on the skin ; B, a black-head plugging 
up the opening; C and E, are soft hairs growing in the 
duct. In old age, when hairs grow out on the face, 
there are no black-heads. Each black-head consists of 
a whitish, fatty plug, formed by the secretion of the 
gland congealing, one end of the plug' being visible at, 
and sometimes extending above, the surface of the skin. 
The exposed end of each black-head becomes black- 
ened by diffused pigment deposited within. Sometimes 
both ends of the plug are discolored by a deposit of 
pigment. 

The predisposing causes of comedones are the same 
as acne, and the same rules observed regarding the 
diet, etc. The local treatment should be directed to 



FEATURAL SURGERY. 225 

stimulate the skin to new activity by vibratory mas- 
sage, electricity, etc. The comedones should be thor- 
oughly removed by pressure between the thumb nails 
or comedones extractor, see cut; a good astringent 
lotion should be applied several times a day, for which 
the lotio alba will answer the purpose, and the skin 
kept clean by the use of soap and water. The follow- 
ing ointment has rendered me good service: 

^ Sulphur 1 dr. 

Green soap 1 dr. 

Precipitated chalk 90' gr. 

Zinc ointment ' 1 oz. 

'Mix direct to cover the skin well on retiring. Wash 
thoroughly the next morning with warm water and 




'mm 

■ COMEDONE SHOWING INSPISSATED SECRETION. 

soap, and most of the black-heads will disappear. The 
application may be repeated at intervals, until all are 
removed. 



MILIUM. 

This disorder resembles comedones somewhat in 
appearance, only the sebaceous glands are distended, 
without an opening, and remain white, while the come- 
dones turn black when exposed to the air. The milia 
are planted under the epidermis, and cannot be removed 
by pressure, unless the skin is punctured. When there 



226 FEATURAL SURGERY. 

are quite a number in one locality, as is often the case 
under the eye, I remove them en mass, by the use of 
the ecorchment treatment or blister. This entirely 
eradicates the difficulty, and leaves a nice, healthy skin 
underneath. 

LENTIGO AND CHLOASMA. 

Freckles and liver spots, in anatomical structures, 
are the same, and consist of an increased amount of 
normal pigment deposited in the mucous layer of the 
epidermis. Freckles are usually caused by the sun's 
rays, and consist of small, pin-headed deposits, which 
often disappear during the winter months. 

Chloasma or liver spots are of larger size, variously 
shaped, more or less defined, smooth patches, either 
yellow, brown or black in color. They may be associ- 
ated with either pathological changes, as in Addison's 
disease, or physiological conditions, as during preg- 
nancy, and the menstrual epoch. 

The following lotion will generally remove these 
pigmentary deposits, if applied several times a day : 

1$ Corrosive sublimate 5 to 12 gr. 

Dilute acetic acid 2 dr. 

Sodium borate 40 gr. 

Rose water enough to make 4oz. 

It is better to test the sensibility of the skin by the 
weaker solution, at first, increasing the strength as the 
point of toleration is learned. The idea is to induce a 
brany desquamation, and as soon as this appears, to 
suspend the application until the exfoliation ceases, 
when it is resumed. 

If you should desire a complete and thorough re- 
moval, the ecorchment treatment is the process to pur- 
sue. Many of our female ''Codfish aristocrats" will 
visit the sea shore, and other watering places, during 
the summer to obtain the rugged complexion, — tan and 
freckles; — and, upon returning home, will pay some 
beauty doctor one hundred dollars to make them a new 



FEATURAL SURGERY. 227 

face, by the use of ecorchment process. Thus we find 
that "for ways that are dark, and for tricks that are 
vain," the heathen Chinese is not the only one that is 
peculiar. 

POWDER MARKS. 

Following each Fourth of July, and the opening of 
the hunting season, physicians are called upon to re- 
move powder marks, as the result of accidents. These 
patients either consult the physician immediately after 
the accident, or dress their own wounds, and detain the 
consultation when they find their faces are permanently 
disfigured, by these unsightly black specks. If the pa- 
tient is seen immediately after the accident, the process 
of permanently destroying these marks is rather an easy 
procedure, but if the skin is allowed to heal over the 
embedded powder, we have a more difficult condition 
to deal with. We will, therefore, outline the treatment 
used in the different stages. 

If the patient is seen immediately after the acci- 
dent, he will, generally, rebel against any interference, 
stating that the parts are too sore and painful, but by 
explaining to him that a "stitch in time saves nine," 
will consent to your advice, and it is usually best to 
give a general anaesthetic in nervous cases. 

When powder is forced under the skin it has pro- 
vided an open wound, and we have direct access to 
each grain of powder. If the open surface is large, 
many of the deposits may be scraped out with the point 
of a knife, but the powder becomes soft when it comes 
in contact with the tissues, and is difficult to remove ; 
therefore the best, quickest, and easiest method to pur- 
sue is to thoroughly scrub the entire area involved, with 
a stiff antiseptic nail or tooth brush, dipped into a full 
strength solution of peroxide of hydrogen. The min- 
ute wounds are somewhat aggravated by the bristles, 
but in no way deter the process of healing, and to be 
sure you are removing every remnant possible, the skin 
should be pinched up in folds, between the thumb and 



228 FEATURAL SURGERY. 

finger, that it will open the wounds, and reach the 
deeper seated particles. This will often be followed by 
''bubbling" at point of entry of tlie powder grains ; after 
this has ceased, it will be found that nearly all the 
powder has been washed out by the bath and efferves- 
cent process. A saturated solution may now be applied 
to the face with absorbent gauze, and allowed to re- 
main a few hours; the minute wound has, by this time, 
closed, and all dressings may be removed. 

As a rule, this procedure will thoroughly remove all 
powder marks. Should any remain, they may be 
treated, later, by pricking an opening to the stain, and 
applying the peroxide of hydrogen. 

The second class of cases are those which were neg- 
lected at the time of the accident, and consult you after 
the openings have healed, containing the embedded 
powder; here we have a more tedious condition to deal 
with. Each mark may be opened with the point of a 
knife, and removed with the peroxide of hydrogen 
treatment. They may also be removed with the electric 
needle, as is superfluous hair, or trephined out, with a 
small dermal punch, about the size of a watch key. A 
slight rotary motion will remove a /'button" of skin, 
containing the discoloration, which is snipped off with 
scissors. These are all very tiresome procedures, and 
it is here that our ecorchment treatment, and canthos 
blister serves us once more. If the discoloration is 
deep seated, I prefer the blister; if more superficial, the 
ecorchment treatment vail suffice. Either treatment 
will, usually, completely eradicate every trace of the 
marks. 

TATTOO MARKS. 

Tattoo marks are generally embedded deeper in the 
skin than powder stains, which makes them more diffi- 
cult to remove. The first treatment used is the Can- 
thos blister. This blister is applied to the entire sur- 
face, if not too large, and removed in about four hours. 
This will be followed by a large vesicle, which may be 
punctured, at its base, and dressed with absorbent 



FEATURAL SURGERY. 229 

gauze; held in place by adhesive plasters. At the end 
of about a week, the scab will desquamate, taking' with 
it a large proportion of the mark ; if there is any re- 
maining, another blister should be applied at once, and 
continue these treatments until you have "lifted" as 
much of the mark as possible, and in many cases you 
will entirely remove these disfigurements. Any remain- 
ing traces may be removed by the Ohmann-Dumesnil 
method, which consists of tattooing the design over 
again with a bundle of six or ten very fine cambric 
needles, tightly wound with silk thread, dipped in a 
glycerine solution of papoid. This is repeated over the 
entire stain ; a local anaesthetic is previously used, to 
obtund the pain of the surfaces. If of quite large size, 
it may be treated at one sitting. The rationale of this 
method is based upon the following principles: the 
digestive principle of the papoid is disseminated about 
the deposit of pigment, thus liberating it, a portion is 
absorbed, in a finely divided state, by the lymphatics; 
another part, probably, finds its way into the upper 
layers of the epidermis, and thence to the surface. In 
this manner, we obtain a disappearance of the pigment, 
by using either of these methods, or, combining the 
two, little difficulty is experienced in removing these 
otherwise indelible marks. 

SMALLPOX PITS. 

Small-pox, acne-pustulosa, and chicken-pox are dis- 
eases which often leave the face in a terrible state of 
repulsive disfigurement, and the physician who can suc- 
cessfully eradicate these ravages of disease can always 
demand a liberal compensation for his services ; it is 
these methods which are most secretly guarded by the 
advertising cosmetic specialists. In these conditions, 
we have cicatricial tissue to deal with ; in fact each pit 
is the result of a minute abscess of the true skin, and 
connective tissue, and in order to be successful with 
our treatment, we must remove all the superficial tissue, 
and dissolve the remaining cicatricial tissue, as far as 
possible. 



230 FEATURAL SURGERY. 

The epidermis may, therefore, be removed, either 
by the ecorchment, blister or phenol method, and as 
soon as the outer skin has been removed, which takes 
with it the greater number of pits, fibrolysin is placed 
over the entire surface, saturated with the solution, and 
held in place by rubber adhesive bandages and the face 
mask; or thiosinamine used by catophoric application, 
as described in treating scars. 



WARTS AND MOLES. 

Warts and moles are the most common of facial 
blemishes, and are also the most easily removed. Of 
the numerous remedies and methods, the chemical ones 
should be the first to consider; before removing these 
growths by this means, the healthy skin, surrounding 
the growth, should be thoroughly painted with collo- 
dion, to protect the healthy skin. I generally do this 
at the office, and give the patient a small vial of glacial 
acetic acid, and instruct her to dip a wooden tooth-pick 
into the solution, and apply it to the wart or mole sev- 
eral times a day; at the end of this time, the wart or 
mole will form into a scab, and gradually disappear, 
leaving very little scar. This is the mildest way; some- 
times this may fail, which is very seldom. I then use 
some of the stronger acids, trichloracetic acid or nitric 
acid ; they may also be removed by electrolysis or car- 
bon dioxide snow, etc. 

WRINKLES. 

If there is any one thing that a woman utterly de- 
spises it is a wrinkle, and as soon as she witnesses these 
landmarks of age developing she, generally, seeks the 
"beauty sharks" for creams, pastes and lotions, that 
she may maintain perpetual youth ; as a rule, they do 
not seek the advice of the dignified physician ; yet any 
advice the physician may impart will be gratefully re- 
ceived by most women, and the process of arresting the 
development, and removing these unwelcome visitors is 



FEATURAL SURGERY 231 

equally divided between medical, mechanical, manual 
and surgical means. We will briefly discuss the sub- 
ject, before entering the surgical field of cosmetics. 

Wrinkles are caused by a relaxed condition of the 
skin, due to the absorption of the subcutaneous tissues, 
in some cases, and lack of tonicity of the integument 
itself, in others. We therefore, find a demand for a 
variety of treatments, with a view of toning the skin 
to its youthful activity; manual and mechanical mas- 
sage has always played an important role. Great care 
should be exercised with these treatments not to mas- 
sage with too great a force, as such treatments will 
invariably do more harm than good ; only the cushioned 
end of the fingers should be used, or the softest kind 
of rubber; with the bell vibratode, the gentle percus- 
sion stroke is preferable to the stroking movement. 

One of the best means of applying massage to the 
face is with vibro-hand apparatus, see illustration; with 
this, you can execute the delicate touch with the finger 
tips, and vibratory movements from this instrument, 
with little or no exertion from the operator. The effect 
from this treatment is very exhilarating. We are in- 
debted to Zabludowski for the most scientific system 
of facial massage, which can be conducted by either 
manual or mechanical means, or a combination of the 
two, as illustrated above. The Doctor gives the fol- 
lowing: 

FACE MASSAGE. 

For a special massage of the face and neck, which 
must be continued for several weeks, or even months, 
to obtain a noticeable result, Zabludowski gives the fol- 
lowing directions: "The massage is best performed in 
the morning, and should last for a quarter of an hour. 
The parts covered with hair, whether shaved or un- 
shaved, are to be avoided by the fingers. The masseur 
stands at the side or behind the patient. 



232 FEATURAL SURGERY 

1. Stroking and kneading of the forehead. 

Kneading is done with the right hand, which moves 
zigzag wise across the forehead, beginning at the bridge 
of the nose and traversing the forehead as far as the 
margin of the hair; whilst the left hand, with light 
stroking movement, beginning at the frontal eminences, 
travels lengthwise over the forehead to the mid-line of 
the occiput. 

2. Kneading of the nose with the balls of the thumbs 
and index-finger of the right hand. 

The zigzag-like light vibratile movement proceeds 
from the tip of the nose to its root, and extends laterally 
over the alse nasi. The left hand of the masseur sup- 
ports the occiput. 

3. Kneading of the left cheek, double movement. 

The right hand, half closed, moves across the face 
from within outwards, and vice-versa, and at the same 
time moves upwards, beginning from the lower jaw to 
the cheek-bone, below the lower eyelids. 

4. Kneading the right cheek with both hands half- 
closed in the vertical direction. 

Chiefly done by the thumb and index-finger ; the lat- 
ter bent at right angles. The movement extends out- 
ward from the lower jaw and right ear over the malar- 
bone to beneath the right lower lid. 

Smoothing the lines of the forehead. 

Stroking with the index and middle fingers of both 
hands across the forehead from the middle line to the 
temporal region. 

6. Vibration of the face. 

The digits of both hands, with the exception of the 
thumbs, are applied to the cheeks, between the malar 
eminences, and the ascending ramus of the mandible, 



FEATURAL SURGERY 



233 



and execute shaking movements, whilst the tips of the 
fingers approach, and move away from each other in 
the quickest possible time. After a number of vibra- 
tions on one part of the face, the vibrating fingers are 
transferred to another part. The thumbs hang free in 
the air. 





VIBRATORY FACIAL MASSAGE. 



7. Stroking the lines under the eyes with both 
thumbs. 

The movement begins on the bridge of the nose at 
the root, and is continued over the cheek-bones beneath 
the lower eyelids as far as the temporal region. 



234 FEATURAL SURGERY 

8. Stroking the lines between the chin and lower lip. 

The movement is executed with both thumbs, begin- 
ning close to the lower lip, and is continued to the 
ascending ramus of the lower jaw. The masseur stands 
on the right of the patient. 

9. Kneading of the neck. 

The movement begins close beneath the chin, de- 
scending upon the throat, and following the direction 
of the neck as far as the upper extremity of the 
sternum. 





VIBRO HAND VIBRATOR. 

10. Stroking and kneading of the right shoulder. 

Whilst the right hand, beginning at the upper third 
of the right arm, makes kneading movements in a trans- 
verse direction over the shoulder-joint, the left hand 
travels with a stroking movement, following the right 
hand, over the region of the shoulder, upwards upon 
the neck as far as the level of the ear." 

One of the simplest and best methods of facial mas- 
sage is by. means of Bier's suction glasses. These 
glasses will obtain sufficient suction to maintain the 
cup in position without support, (see illustration.) 
These can be moved about the face in any direction, 
and will retain the suction, and is one of the most in- 
vigorating treatments in our possession. 

Another very popular method to remove wrinkles is 
by the use of the face mask, before applying the mask, 
the entire skin of the face is stretched backwards and 
downwards and the mask is adjusted as tightly to the 



FEATURAL SURGERY 



235 



skin of the entire face as possible. This smooths out 
the wrinkles, and by continuous use most excellent re- 
sults may often be obtained. The mask may only be 
used at night. 








APPLICATION OF WRINKLE ERADICATORS. 

Another similar treatment of pressing out wrinkles 
is known by the alluring name of ''Wrinkle Eradicators 
and Frowners," and are sold in large quantities, by a 



236 FEATURAL SURGERY 

company in Cleveland, Ohio. These plasters, however, 
are not to be compared with the common adhesive 
plaster, which has more body to retain the skin 
stretched, after being applied. These plasters are used 
at points where wrinkles are found in profusion, as at 
the corner of the eye, for crows feet, under the eye, etc. 
The method of application is illustrated in the accom- 
panying drawings. 




METHOD OF APPLYING WRINKLE ERADICATORS. 

COMBINATION TREATMENT. 

One of the most invigorating and effective home 
treatments for the removal of wrinkles, and keeping the 
face young, is by combining several of. these methods 
as follows: the face is first massaged with the hand, 
with the vanishing face cream; this is followed by the 
Bier's cup, the adhesive plasters are applied to the deep 
seated wrinkles around the eyes, forehead, etc., over 
which the face mask may be applied. The only time 
this treatment is used is just before retiring, as the face 
during the sleeping hours is placid. All these dressings 
are removed in the morning, and the face massaged for 
the day. By following this treatment for sometime, it 
is often surprising; the youthfulness which can be re- 
stored to an old face. Many facial specialists precede 



FEATURAL SURGERY 



237 



this treatment with the ecorchment treatment, which 
also adds to the beauty of the integument. 

The surgical treatment of wrinkles consists, prin- 
cipally, of paraffin injections, to fill in deep crevices, 
and what is referred to as "wrinkle tucks." Paraffin 
may be injected under deep crevices of the face, as the 







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RESULTS OF COMFINATION TREATMENT FOR WRINKLES. 

naso-labial line, and the transverse furrows of the fore- 
head, to raise the skin to a levei with the rest of the 
face. 

Wrinkle tucks are taken about one-quarter of an 
inch back from the hair margin in the scalp. The scalp 
is shaved, and various sized pieces of skin are dissec- 



238 



FEATURAL SURGERY 



ted away, and the edges of the wound united. This 
draws the skin of the face up and back; after this 
wound has healed the hair is combed back, which cov- 
ers the wound. These tucks are also sometimes taken 
below the inferior maxillary bone, to draw the skin 
down and back. Such operative procedures may seem 
ridiculous to the conservative physician; yet it is these 
operations which fatten the purse of many unethical 
and ethical physicians. 




VARIOUS DEFORMITIES OF THE NOSE. 



DEFORMITIES OF THE NOSE. 

The nose is the protruding organ of the face, and 
is, therefore, the most often injured or deformed by 
accident or otherwise ; it was this part of my anatomy 
which always seemed to be in the way during pugilistic 
contests in college days. These deformities are ex- 
tremely conspicuous, and have been classed as follows: 
(See cuts 1, 6 and 10, illustrating the different degree 
of concave, or what is referred to as the saddle back 
nose. These deformities are often found at birth, 
but are generally due to a severe blow, completely or 
partially, breaking the bony frame work, or bridge, 
giving the nose a very unpleasing appearance. Cuts 2 
and 7 represent the humped nose. This deformity is 
not what is generally called the Roman nose, as the 
bridge is much broader, and gives the nose a very 
clumsy and massive appearance, independent of its con- 



FEATURAL SURGERY 



239 



vex shape. Cut 3 is the broad nose as is found in the 
negro. Cut 4 represents the lateral tipped nose, which 
is generally due to accidents of the cartilaginous por- 
tion of the nose. Nos. 5 and 8 are the receding nose, 
which is usually caused by syphilis, scrofula and other 
destructive diseases of the septum. Cut 9 is the nar- 
row nose which not only gives the face a miserly ap- 
pearance, but often interferes with respiration. We 
also have the bulbous nose, the hawk billed nose, the 




METHOD OF INJECTING PARAFEIN FOR CONCAVE NOSE. 



split septum, etc. Each deformity representing differ- 
ent characteristic forms of unpleasing conformity, which 
require our personal attention, to adjust and restore to 
a natural and pleasing contour. 

Of all the deformities of the nose the concave or 
saddle back nose, (Figs. 1, 6 and 10), is the most fre- 
quently met with, and is also the easiest to restore to 
its normal shape, by the use of paraffin injections, as 
follows: the paraffin is prepared at a melting point, 
between 110 and 115 degrees F. The nose and instru- 
ments are treated antiseptically, the needle of the 
syringe, containing the paraffin in a semi-solid or half 
cooled state, is inserted to a point of the greatest de- 
pression in the convexity, and while the assistant is 



240 



FEATURAL SURGERY 



making pressure on both sides of the nose, to avoid 
having the paraffin spurt in some open channel, where 
it is not desired, the screw on the piston stem is gently- 
turned, and after sufficient paraffin has been injected to 
raise the surface, it is molded into shape either by the 
assistant or surgeon. Great care should be exercised 
not to inject too much paraffin, as these injections are 
followed by inflammation and infiltration, which sub- 
sides, leaving the tissues somewhat thickened, and if 
care is not exercised in this point, we may convert a 
concave nose into a convex one. The opening should 
be sealed with collodion and the nose treated with 
aseptic dressings. 




THE CORRECTION OF PUG NOSE. 



THE HUMPED AND ROMAN NOSE. 

This deformity, (Figs. 2 and 7), is restored to its 
normal shape by an oblique incision, to prevent scar 
tissue. The incision is made along the median line. 
The opening is enlarged sufficiently to admit the in- 
struments required, which consist of bone scissors, 
rongier forceps, and a slender saw, and such other in- 
struments as may be necessary. After the skin is ele- 
vated from the deformed surface, the nasal bone is 
sawed off, and the edges trimmed smoothly, with a pair 
of slender bone-clipping forceps, so as to give the nose 
the exact contour desired. After the parts are thor- 



FEATURAL SURGERY 



241 



oughly cleansed, and rendered aseptic, the skin is re- 
placed, and united in as close apposition as possible, to 
avoid scar tissue. What scar tissue remains may be 
removed, later, by the usual way of removing this tissue. 

THE BROAD NOSE. 

This deformity, (Fig. 3), which resembles the negro 
nose, is corrected by overcoming the elasticity of the 
wings, by incisions through the shield cartilages, sub- 
cutaneously, with a slender knife, in several places, and 
then holding them in place, by an external form, until 
they are firmly fixed in the desired position. In some 
cases the cartilage is so redundant as to require the 
excision of a portion of the same. 




THE CORRECTION OF NARROW NOSE. 



THE NARROW NOSE. 

This deformity, (Fig. 9), is corrected by incising the 
cartilage at its base, and forcing the cartilaginous wings 
outward from the septum, and holding it there by 
sutures, and mechanical means; by inserting antiseptic 
"plugs" into each nostril, and retaining them there 
until the cartilaginous tissues are firmly fixed. 

THE TILTED TIP NOSE. 

To correct thts deformity, (Fig. 4), a narrow bladed 
knife is inserted at the margin of the skin and mucous 
membrane, at the middle of the septum, and the point 
of the knife Ts directed upwards to the point of bone 



242 



FEATURAL SURGERY 



and septum, or the angle of the tilt. The septum is 
divided, and the tip of the nose is forced to the oppo- 
site side, and a little beyond, and held in this position 
by mechanical means, with "plugs" within the nostrils, 
and rubber adhesive strips, passing over the nose, and 
attached to the cheek, after the septum has been re- 
united, the dressings may be removed, but if the tip 
has a tendency to go beyond the median line, the ad- 
hesive strips should again be applied until the tip of 
the nose is trained to its normal position. 

THE RECEDING NOSE. 

This deformity, (Figs. 5 and 8), is often one of the 
most difficult derangements we have to correct, as the 





METHOD OF INJECTING A RECEDING NOSE. 

septum is often destroyed, either by accident, or dis- 
ease, of which syphilis and scrofula bear their destruc- 
tive influence. We may build out many of these re- 
ceding tips with paraffin, as is illustrated here, but if the 
septum is so destroyed that it will not bear support by 
artificial means, as is the case with aU deformities of 
the nose, there are no two cases exactly alike, and it 
will depend upon the surgeon's judgment and mechan- 
ical genius to find a way of properly adjusting these 
deformities of the nose. In this class of deformities, 
we may be required to supply a silver or other metallic 



FEATURAL SURGERY 243 

support, embedded in the tissues, or force support from 
some other source. The same rule applies to surgery 
of the nose, as in other parts of the body, and if a 
patient has an abundance of tissue he wishes to dispose 
of, cut it out, or fill in the deficiencies by any of the 
means offered in modern surgery. 

PROTRUDING EARS. 

Protruding ears may be either hereditary or ac- 
quired. The latter condition is frequently the result of 




LINE OF INCISION FOR CORRECTING PROTRUDING EARS. 

wearing a stocking cap by children. I have had two 
very interesting cases traced to this cause, which came 
from Upper Canada. The boys were exposed to the 
cold much of the time during the winter, and would 
pull their caps over their ears, which trained them to 
protrude. The same treatment may be used to force 
them back to their normal position, by the use of the 
ear truss, (as is illustrated here), or a slight operation 



244 FEATURAL SURGERY 

will rapidly return them to their natural condition. The 
technique is as follows: The line of incision is marked 
off, behind the ear, on both the mastoid process and 
ear, so that the apposition of the skin, at the border 
of the surfaces will meet perfectly; the integument is 
now removed, and the borders of the skin united with 
sutures, and dressed antiseptically. To hold the ear in 
contact with the mastoid surface, a cloth bandage is 
placed around the forehead, and back of the head, and 
one over the head and under the chin. These bandages 
are held in place by reinforcing them with adhesive 
strips; this is the most popular way of "resetting ears," 
as it is frequently referred to. Other operations con- 
sist of removing parts of the cartilage. - 

RECEDING CHIN, HOLLOW CHEEKS AND 
DEPRESSED SCARS. 

It is these operations in which the use of paraffin 
reaches its greatest degree of usefulness, and can serve 
for the noble purpose of restoring contour to unsightly 
depressions, and defects, which cannot be reached by 
any other means, and in this capacity its usefulness is 
almost unlimited, grading in degrees of magnitude, 
from elevating a small pox pit to the complete filling in 
of cavities, after resection of bone, from the upper and 
lower jaws, and other parts of the face. The writer 
had one case of congenital malformation, hemiatrophia 
facialis, in which nearly five ounces of paraffin was in- 
jected, to restore contour to the face, and the result 
was almost perfect. 

The receding chin, small-pox pits, depressions from 
abscesses, the eradication of the naso-labial line, hol- 
low cheeks, and many other deficiencies may be re- 
stored to perfect contour by the use of paraffin. 

It was formerly believed that liquid paraffin would 
answer the purpose for elevating surfaces upon the 
face, and leave the tissues soft and pliable, but these 
operations were failures, as the paraffin would become 
absorbed, in a few months' time. There is a great deal 
of tension when paraffin is injected over bone, and tht 



FEATURAL SURGERY 245 

melting point should never be lower than 110 degrees 
F., and it is still better to use a higher melting point 
for receding chin. 

The technique for the use of paraffin is given else- 
where, which applies, in general, to all paraffin opera- 
tions ; we therefore, refer you to the preceding chapter. 

SCARS AND BURNS. 

The removal of cicatricial tissue, as the result from 
cuts, burns, bruises, abscesses, etc., is one of the most 
frequent blemishes the physician is requested to re- 
move, and the treatment required, and the degree of 
success obtained, will depend upon the length and 
breadth of the scar. In order that I may implant firmly 
in the reader's memory, I wish to repeat what has 
already been said, in a preceding page, "we may mutil- 
ate, cut, bruise, or destroy the first four layers of the 
skin as much as we like, without leaving any cicatricial 
tissue, but when we go below the epidermis into the 
true skin, our operations are always marked by the 
formation of cicatricial tissue. 

We may desquamate the outer skin, and draw to 
the surface cicatricial tissue, from the true skin, by a 
process of blending and absorption, by continually re- 
moving the outer skin. In order that I may demons- 
trate this process I will cite the following case: 

Mr. H., was kicked by a horse when nine years old, 
resulting in a depressed scar, about three inches long 
and three-quarters of an inch wide; the wound was 
united at the time, which was followed with septic in- 
fection, with considerable sloughing of tissue, which 
left a deep depression. The first step to be considered 
was to dissect away all the cicatricial tissue, and unite 
the edges of the integument in as close apposition as 
possible, (see scarless surgery) ; we now have left a 
slight line of cicatricial tissue, and a deep depression to 
deal with. The next step was to elevate the depres- 
sion by an injection of paraffin to a level with the face; 



246 FEATURAL SURGERY 

this was allowed several weeks, for the reaction to sub- 
side, and thoroughly heal, and the only trace left was 
a fine lineal scar where the skin was united. The 
patient was so well pleased that he wished it to remain 
as it was, but I encouraged him to completely eradicate 
every mark possible. I, thereiore, proceeded to apply 
a thin strip of Canthos blister plaster, along the entire 
line of incision; this was applied at five dirrerent times, 
which still reduced the cicatricial tissue, so that it 
could not be noticed at six feet distance. The patient 
was then given a ten percent thiosinamine ointment 
which was applied for some weeks; today, it will al- 
most require a magnifying glass to find any trace of 
scar tissue, and the operation may be considered per- 
fect. 

Within the last two years I have used the thiosin- 
amine by cataphoresis as suggested by Dr. Xieswanger. 

Thiosinamine, and its double salt, fibrolysin, is used 
to such an extent in the treatment of many diseases 
given in this publication that it is well to have a clear 
conception of the therapeutic value of these two pro- 
ducts. 

THIOSINAMINE AND FIBROLYSIN. 

Thiosinamine is a synthetic preparation made from 
the artificial oil of mustard, and appears in clear crys- 
tals, of faint garlic odor, and bitter taste, and is only 
slightly soluble in water, but can be made more soluble 
by the addition of glycerine and aqueous solution. It 
is very soluble in alcohol and ether, but, owing to the 
pain caused by the hypodermic injection of alcohol, it 
has been superseded, under the coined name of ''Fibro- 
lysin," which is a double compound of thiosinamine and 
sodium salicylate. It was first prepared by Dr. F. 
Mendel, of Essen-Ruhr, who, by combining two mole- 
cules of thiosinamine with one molecule of sodium 
salicylate, produced a white crystalline powder, soluble 
in both hot and cold water. This he found unirritating 
when injected. 



FEATURAL SURGERY 247 

Fibrolysin has the same indications as thiosinamine ; 
it is a cicatricial and glandular resolvent; but it has 
the advantage of quicker absorption, and freedom from 
pain or irritation, upon injection, on account of its 
solubility and aqueous vehicle. 

Most authors agree that thiosinamine alone is in- 
effectual when given by mouth, while subcutaneous ap- 
plication is unsatisfactory, owing to its slight solubility 
in water, and the pain which always follows when given 
in alcoholic solution. On the other hand, when com- 
bined with sodium salicylate, in t,he form of Fibrolysin, 
if the usual antiseptic, and other precautions are ob- 
served, injections are painless, and irritation at the site 
of an injection rarely occurs. 

We, therefore, find that the therapeutic application 
of thiosinamine and fibrolysin may be utilized, either 
internally, in one-half grain doses, by inunction, in a 
ten to twenty-five per cent ointment, by hypodermic 
medication, (fibrolysin), and by cataphoric application. 
With these four methods of medication at our disposal, 
we are not only able to dissolve cicatricial tissue, as 
found in scars, strictures, corneal opacites, etc., but also 
to reduce hypertrophied glands, and superfluous tissues, 
thiosinamine being preferred for cataphoric purposes in 
the following formula: 

I£ Thiosinamine y 2 dr. 

Glycerine 1 dr. 

Aqua dis . 1 dr. 

Sodium chlor 3 gr. 

A piece of absorbent lint is cut to cover the surface 
of the scar tissue, if not too large, and saturated with 
the above solution. This is placed in a special elec- 
trode, (see cut), and applied firmly against the scar, 
using the positive pole of the galvanic battery; the neg- 
ative pole is placed at any convenient place, and the 
current turned on, in strength from four to twenty 
milliamperes. Each sitting should be continued about 
ten minutes ; in three or four days the skin, over the 



24S 



FEATURAL SURGERY 



scar, will become dead, and peel off, when another 
treatment may be used until the scar tissue entirely 
disappears. 




CATAPHORIC ELECTRODES. 

GOITRE. 

This same procedure is also used for fibrous degen- 
eration of the thyroid gland, with marked success; the 
positive electrode being packed with absorbent gauze, 
and saturated with the thiosinamine solution, can be 
applied to sections of the goitre, until the entire en- 
larged surface is treated, in different areas. The best 
place to apply the negative pole, for the treatment of 
this affection, is upon the abdomen; the amount of cur- 
rent tolerated, by most patients, is from twelve to 
twenty milliamperes to obtain success. Patients should 
receive three treatments each week, and the duration of 
each treatment should be about ten minutes. Solutions 
of iodide of potassium have also been used to a good 
advantage by cataphoric applications. 



PUFFINESS UNDER THE EYES— DOUBLE OR 
. BAGGY CHIN. 

Pufnness under the eyes has always been associated 
with Bright's disease, and other kidney disorders ; 
although the condition may be a symptom of kidney 
disorders; we often find that it presents itself 
spontaneously, in perfectly healthy people, and is one 
of the most damaging disfigurements to the facial ap- 



FEATURAL SURGERY 



249 



pearance, as it produces an expression of sadness, mel- 
ancholy., or ugliness, and many faces, which otherwise 
have a fine complexion and contour, are ruined by this 
"bloating" under the eyes. 

The double or baggy chin, which consists of a super- 
fluous amount of flesh, hanging from the chin, reacts 
to a disadvantage in many ways ; it not only mars the 
general contour and expression of the face, but also 
draws deep lines elsewhere on the face, and it is sur- 





BAGGY OHIN AND PUFFINESS UNDER THE EYES. 



prising to note the wonderful improvement which takes 
place after removing this superfluous flesh. The skin 
of the face proper becomes more tense and transparent, 
the deep lines disappear, and the general expression as- 
sumes a more youthful appearance. In both of these 
conditions we have a superfluous amount of flesh to 
deal with, and it has been the custom of featural sur- 
geons, in the past, to deal with these conditions purely 
upon a surgical basis, and dissect away this over- 
amount of redundant tissue. More satisfactory results 
have been obtained by making compresses of the thios- 
inamine solution, as used for goitre and scars ; to obtain 
results, a pad of absorbent gauze is saturated with the 
solution, and applied over the area of superfluous tis- 
sue. This is held in place, so as to make heavy pres- 
sure, during the sleeping hours, and held in position 
with adhesive strips under the chin, and over the head, 



250 



FEATURAL SURGERY 



for a baggy chin, and the face mask is used for both 
the chin and puffy eyelids. This preparation is also 
used by cataphoresis, as in goitre, and for removing 
scar tissue. 

BIRTH MARKS. 

Chief among facial blemishes, which constitute a sad 

disfigurement, that renders the possessor a recluse from 

society, are birth-marks, (pigmentary nsevi). These 

marks are generally noticed at birth, hence their name, 




RESULTS OF CARBOX DIOXIDE SHOW FOR THE REMOVAL OF 
BIRTHMARKS. 



and come under the classification of tumors, by the 
name of angioma, to which you are referred ; these 
tumors consist of a net-work of dilated blood vessels, 
either arterial or veinous. Until within recent years 
these marks were not considered removable, and their 
unfortunate possessors were doomed to exist with these 
"princes of disfigurement," and obstacles, throughout 
their lives, which were a constant annoyance in both a 
social and business way. 

Modern therapeutics offer many methods in which 
these marks may be removed. The point aimed at is 
to destroy, or contract these anastomosing, dilated ves- 
sels. Very superficial marks may often be removed by 
the blister treatment, but the deeper seated lesions will 
require a more destructive influence, for which carbon 
dioxide snow perhaps offers the greatest advantage: 



FEATURAL SURGERY 251 

the technique for using this, for birth-marks, is the 
same as for other neoplasms, given elsewhere. It will, 
therefore, not be necessary to repeat the details here; 
the accompanying illustration shows the results, which 
may be obtained from this indispensable element, and 
if due caution is exercised, not to freeze too deeply, 
the cosmetic effect is the best at our disposal. Most 
excellent results have been obtained by the use of tri- 
chloracetic acid for this purpose. 

Electrolysis offers us a means of cauterizing these 
minute blood vessels, and obliterating the discoloration 
and disfigurement they produce. The area is anses- 
thised, either by hypodermic injections of quinine and 
urea hydrochloride, or by the cataphoric application of 
cocaine. A sharp pointed needle, attached to the nega- 




ELECTRODE FOR MULTIPLE ELECTROLYSIS. 

tive pole, is entered at the border of the mark, to 
transfix the growth beneath the skin, in lines of about 
one-twelfth inch apart; this is followed by the same 
process in a transverse direction, until the growth has 
been blocked, like a checker-board, (see illustration). 
This thoroughly cauterizes the small blood vessels, and 
in a few hours, the mark will assume a brown appear- 
ance, which forms an eschar that desquamates in a few 
days, taking the mark with it. If any remnant should 
remain, it may be followed with other treatments, until 
it entirely disappears. Caution should be exercised not 
to cauterize too long, or too deeply, lest an unsightly 
scar may result. It is the practice; nowadays, to use 
several needles, (see illustration), on one electrode, in- 
stead of the single needle, as it saves time. This pro- 
cess is referred to as multiple electrolysis. 

Dr. Nieswanger highly recommends the following, 
where the mark is not elevated : 



252 FEATURAL SURGERY 

I£ Antim. tart 1 dr. 

Soap plaster 3 dr. 

Green soap 1 dr. 

M. This is applied on adhesive plaster, about 1-12 
inch thick, over the entire surface. The healthy border 
should be painted freely with collodion, to protect the 
normal skin; at the end of from three to five days, the 
full escharotic effects are evident, and the plaster re- 
moved, and the surface dressed with 

I£ Zinc oxide 20 gr. 

'Cold cream 4 dr. 

This treatment will produce excellent results in many 
cases. 

HARE-LIP AND CLEFT PALATE. 

These two deformities come within the scope of the 
featural surgeon, and it is well to consider the best 
means for their correction. Dr. D. La Ferte, in a 
recent article, gives the following technique for the cor- 
rection of hare-lip, which will leave only a slight trace 
of the operative procedure : 

"In the treatment of hare-lip the efforts of surgeons 
for the most part have been directed toward closing the 
fissure in such a manner as to make the lip of uniform 
thickness, and to avoid leaving a dimple in the vermil- 
ion border of the lip at the junction of the two flaps. 

Little effort has been made, in planning the different 
operations, to so plan the trimming of the edges that 
in the male child when he grows up and desires to wear 
a mustache the part in the mustache may be in the 
median line and not to one side of the column of the 
nostrile. I venture the assertion that many grown-up 
individuals whose mustaches part to one side on ac- 
count of a previous operation for hare-lip would will- 
ingly submit to an operation for remedying that defect 
if they were cognizant of the fact that such an opera- 
tion was practical. Another point that has been sadly 
neglected is the flattened and depressed nostril that is 
generally found on one side of the nose. 



FEATURAL SURGERY 



253 



The late Dr. A. M. Phelps was the first, I believe, 
to call attention to the desirability of throwing the scar 
in the median line of the lip. The drawings in this 
article are largely copied from an article from his pen. 

The object of the operator should be to make as 
artistic a lip as possible, and not only to close the fis- 
sure in as easy a manner as possible. He should try 
to have a lip that shows a graceful curve from each 
corner of the mouth to the median line, where it 
should terminate in a slight prominence, as seen in 
Fig. 3. That should be our aim, but it is not always 
possible to be as successful as we desire. 




HAIR LIP OPERATION. 

Describing the different steps of the operation should 
aid in its understanding. First take a loop of silk 
through each angle of the lip, at 4 right side and at 4 
left side (Fig. 1). These are made taut by traction 
with the left index-finger, which aids to steady the 
parts, and thereby facilitates the other steps of the op- 
eration. By means of scissors or knife the lip together 
with the depressed ala of the nose are dissected from 
the bone, and if deemed advisable the ala of the nose 
may be slightly detached also upon the other side. The 
upper lip must be sufficiently detached so that it can 
move freely over the bone. With a tenotomy knife 
puncture the lip at aa, Fig. 1, the parts being put upon 
the stretch by making slight traction on the silk loops. 
The incision should describe a curve, following the dot- 
ted line to 2, and from there to 3 (see Fig. 1); then 
cut from 3 to 4 through the entire thickness of the lip. 



254 



FEATURAL SURGERY 



(Fig. 1). The pieces B and B are now turned down- 
ward, leaving the V-shaped piece seen in Fig. 2. Now 
sew the raw edges together (I prefer fine silk "for that 
purpose), when the result will appear as shown in Fig. 
3 ; raise the lip and sew the mucous membrane as high 
as possible. 

We should always allow for a certain amount of 
retraction. Therefore care must be taken that the 
pieces B and B shall be longer than is actually neces- 
sary. If there is too much redundant tissue, that can 
be trimmed off at the last stage of the operation. This 
operation is practicable in all cases of single hare-lip 




RESULTS OF OPERATION. 



where one-quarter of the length of the lip remains be- 
tween the fissure and the corner of the mouth. The 
punctures at 2, Fig. 1, should be at equal distance 
from each corner of the mouth, and both nostrils should 
be entered at the same point on each side (3, Fig. 1). 
The V should be about one-half the normal width of 
the lip. If the V should be cut too short, the defect 
can be remedied by making a transverse cut through 
the whole thickness of the lip around the ala of the 
nostrils. If the V is left too long, it would cause the 
middle of the vermilion border of the lip to drop too far 
down at the median line. These same incisions can be 



FEATURAL SURGERY 255 

made in cases of double hare-lip, saving the center from 
which the V is made (Fig. 4). This figure gives, a 
good illustration of the manner in which the incisions 
are made in cases of double hare-lip. 

I had occasion lately to put this operation in prac- 
tice at the Children's Free Hospital for single hare-lip 
in a boy fourteen years of age, who said he had been 
operated on twice for his defect since birth, and whose 
lip when he came to me was in the condition repre- 
sented in the accompanying illustration. 

My incisions were planned as indicated in Fig. 1, 
and the flaps brought together as shown in Fig. 3 ; the 
result shows an artistic lip with the scar directly under 
the column of the nostrils (Fig. 6). 

This method of operating I have followed for some 
time, and I feel pleased with the results. 

Where one nostril is depressed and the ala of the 
nose upon one side spread out upon the face, I dissect 
the ala of that side from the bone and put in a button 
suture, penetrating from the depressed and loosened ala 
through to the fixed ala of the opposite side. In about 
five days the suture is removed, when the lip will be 
found to have become attached to the raw surface of 
the bone underneath and the wing of the nose to have 
become elevated. 

Dr. Dean Smith's operation for cleft palate is per- 
formed as follows: The flaps are made in the usual 
way, - cutting the muscles that would interfere with 
the easy bringing together of the margins. The edges 
being pared, the mattress sutures are introduced and 
tied. These are of silkworm gut. In placing them, the 
needle enters the flap near the end, about midway be- 
tween the margin, and the lateral incision. It passes 
obliquely through the tissues, and emerges on the under 
(upper, according to the position of child), side near 
the free edge. The needles enter the other flap on the 
under side, near the margin, and opposite to the point 
of emergence from the first flap. It passes obliquely 
upwards, through the tissues, coming out on the free 
surface, at the same relative position that it entered 



256 



FEATURAL SURGERY 



the first flap. It now retraces its course through the 
flaps, parallel to the first part of the stitch, and about 
a quarter of an inch from it. This thread makes the 
mattress suture, and when it is tied, it will bring the 
margins together. Rather, it will bring the lower 
edges of the margins together, rolling the outer edge 
out. This will give us the broadest possible coating 
surface, when the marginal sutures are placed. Two 
or three mattress sutures will be required to control 
the whole length of the flap. It is evident that if these 
stitches are properly placed they will take all tension 
off the coapting, or marginal sutures. I have seen it 
stated by one surgeon that he uses silk, instead of silk- 




CLEFT PALATE OPERATION. 



worm gut, because the latter irritates the tongue. An- 
other surgeon uses the silkworm gut, because it will 
irritate the tongue, so that the child, will keep it away 
form the flaps. The silkworm gut serves a good pur- 
pose. Unless the gut is very fine and pliable, silk 
should be used in the uvula. I have discussed the 
treatment of cleft, involving the palate bones. The 
mattress stitch is just as important when the cleft is 
only through the soft palate. 

The cleft or clefts, through the maxillary bones, re- 
quire an entirely independent operation. This opera- 
tion is done at the same time as the palate operation, 
or soon after. The proper management of the pre- 
maxillary bone will help, materially, in closing the 
space in the palate that could not be closed with the 
flaps. It is my practice to break this bone loose, if the 
cleft is wide, and push it back, or downward into appo- 



FEATURAL SURGERY 257 

sition with the edge of the maxilla. If the cleft is un- 
ilateral and the pre-maxilla cannot be broken and re- 
duced, I cut through .the alveolar juncture of the oppo- 
site side with bone shears so as to partially free the 
portion we wish to displace. When the lip is repaired 
it tends to hold the fragment back so the opening in the 
palate may entirely close in a year or two. 

Before using the mattress suture, it was the excep- 
tion to have a case hold throughout the entire length 
of the cleft. We often had to make two and some- 
times three operations before we were satisfied with 
the result. I may have been less skillful than other 
operators. I do not wish to boast of inefficiency, but 
state these facts for the sake of comparison. J know 
that since using the mattress suture, I expect and usu- 
ally get complete union the first time. 

Of the cases treated with the mattress stitch, one 
was a failure. The patient was a tiny delicate baby, 
with an exceedingly wide cleft of both palate and lip. 
Because of the frail appearance of the child I hurried 
the operation. The haste was unnecessary for, when 
the work on the palate was completed, the pulse and 
respiration were about as good as when we began. We 
then repaired the lip. The child suffered but little from 
shock. 

The mattress suture will not cause the parts to heal 
unless the balance of the work is properly done. 

In one other case, the uvula did not hold. It was 
this case that led to the suggestion regarding silk 
sutures in this part of the palate. 

All the other cases held throughout the entire 
length of the cleft. 



THE HAIR 



The Hair. 



The hair, being an appendage to the skin, comes 
within the category of cosmetic therapeutics, and the 
conditions which, apparently, require the greatest atten- 
tion, are directed in the extreme opposite ; therefore too 
much, or too little, hair are the two conditions in 
which the physician is consulted for advice. A luxur- 
iant growth of hair, in the right place, is always re- 
garded as particularly beautiful, but when hair grows 
in the wrong place, it is considered one of the greatest 
cosmetic evils, and a "mannish woman" is as greatly 
disliked by the opposite sex as the "ladylike man." It 
is, therefore, well to discuss the means of correcting 
and restoring these defects. 




HIRSUTE MONSTROSITIES. 

SUPERFLUOUS HAIR. 

If we were to accept the theory of evolution, our pre- 
historic ancestors, perhaps, all possessed a luxuriant 
growth of hair upon their bodies, but as civilization 
has advanced, this condition disappeared, evidently, 
with our simian tail, and now we have only a stubby 



THE HAIR 



259 



coccyx, and a smooth skin, as a result of the evolution- 
ary progress. There are many hirsute monstrosities, 
however, as is illustrated by the bearded lady, and the 
little girl, whose body, and part of her arms, were cov- 
ered with a heavy growth of hair. 

Many of us have seen the lion-faced Russian boy, 
whose entire face was covered with hair, which gave 
him the appearance of a poodle dog, rather than a 
man. The most remarkable case, however, was that of 
Giuseppe Mason, who was, for many years, sexton of a 




GIUSEPPE MASON'S CASE. 



church in Padua. In 1903, Mason's head become en- 
tirely bald, though he did not lose his beard; later, he 
fell sick with the la grippe, arid went to a hospital ; 
while he was convalescing from his illness, a soft down 
began to grow, not only on his head but upon his face 
and body. This soft silky hair increased in length and 
thickness, until he was completely enveloped with hair, 
as in the accompanying illustration. This case has 
puzzled scientists more than any ever presented. 



260 THE HAIR 

REMOVAL OF SUPERFLUOUS HAIR. 

We have two ways of destroying superfluous hair; 
only one of these, however, will give permanent results. 
All the so-called depilatories on the market depend upon 
some one of the sulphides for their destructive influ- 
ence ; of these barium, strontium, calcium and sodium 
are the elements in general use. Of these salts, barium 
has seemed to be the most popular. I prefer strontium, 
however, as it is less irritating to the skin. 

The stereotyped phraseology of the advertising spe- 
cialists is to advertise "it is a liquid," and I spent some 
time and expense, to discover that it was sulphide of 
sodium they were using, as sodium is the only one of 
these salts which is soluble in water; it is also more 
irritating to the skin, but I believe the final results are 
better than those obtained from the other salts. 

Dr. Lutje was the first to call our attention to the 
fact that better results may be obtained by applying the 
sulphide of barium, strontium and calcium while hot; 
by this method, the depilatory is less irritating and 
more effective. 

To prepare such mixture 1.5 grams of strontium 01 
an equivalent quantity of barium or calcium sulphide 
are triturated with 2 grams of starch and 8 grams of 
water, and the mixture heated to boiling, with contin- 
uous stirring; upon cooling, a creamy mixture is ob- 
tained, which is as efficacious as the mixture prepared 
in the cold, and does not irritate the skin. If this is 
immediately placed in collapsible tubes, and kept her- 
metically sealed, it will last indefinitely, and will pro- 
duce a better article than most preparations found upon 
the market. This paste should be applied to the sur- 
face of the skin containing the hair, and in two or 
three minutes the hair will be noticed to shrivel up and, 
apparently, become dissolved. The paste containing 
the hairs may now be scraped away with the back of a 
knife, or other blunt instrument ; the- face thoroughly 
washed and cold cream applied; this treatment is not 
intended to permanently destroy the hair, as most of 



THE HAIR 



261 



the hair will return. I believe, however, that a certain 
percentage is permanently destroyed. This is verified 
by a series of experiments I have conducted upon 
my arm. 




PORTABLE COSMETIC BATTERY AND APPARATUS. 



1 Hard Rubber Needle Holder. 

6 Hayes' Bulbous Pointed Needles. 

2 Steel Broaches. 

1 No. 114 Magnifying- Glass. 

1 pair No. 72 Forceps. 

1 No. 3 Hand Spongio Electrode. 

1 No. 3 5 Ha 



1 pair Conducting Cords. 

1 pair No. 1 Universal Wood Hnadles. 

1 pair No. 1 Spongio Discs. 

1 pair No. 40 Metal Handles. 

1 No. 30 Wrist B'and Electrode. 

1 No. 11 Massage Roller. 
Brush Electrode. 



ELECTROLYSIS. 

Electrolysis is the only positive and permanent 
method of removing superfluous hair, and although the 
galvanic current may be utilized from a public lighting 
system, I prefer a special fourteen-cell battery, designed 
for cosmetic purposes, (see illustration), as I believe 
the current is more agreeable to the patient and of suf- 
ficient strength for all cosmetic operations. 



262 



THE HAIR 



Before removing superfluous hair with the electric 
needle, the surface to be operated upon should be 
treated with a four to ten percent cocaine solution, by 
cataphoric application, as is described on a preceding 
page ; using the same electrode as is used for thiosin- 
amine. The operating room skould be provided with 

good light, as these opera- 
tions are very tiresome to 
the eye. A magnifying glass, 
attached to the forehead, as 
is illustrated here, is also a 
great convenience, and if this 
work is done at night, the 
electric head lamp may be 
used to a great advantage. 

The surface operated upon 

should be thoroughly cleaned 

and dried, and the spongio- 

covered electrode connected 

magnifying glass to the positive pole, should 

be placed on one of the hands, previously moistened 

with water, and if your current is weak, or the patient 





ELECTRIC HEAD LIGHT 



does not press the electrode firmly, this electrode should 
be saturated in a salt solution, which gives strength to 
the current. The needle is attached to the negative 



THE HAIR 263 

pole, and held by a needle holder. The skin containing 
the hair is now stretched by the thumb and finger of 
the operator's left hand, and the needle is inserted in 
the hair sheath, parallel with the hair, to the papilla; 
the patient is requested to press firmly upon the posi- 
tive electrode in her lap. This completes the current, 
and if the current is strong enough, froth will be ob- 
served where it entered the follicle; if this does not 
occur, the current is not strong enough, and more cur- 
rent should be turned on. Slight traction upon the hair, 
with the epilation forceps, will determine if the opera- 
tion has been successful. If the hair is not easily re- 
moved it indicates that the operation has not been suc- 
cessful, and the needle should be applied again. It is 
well not to remove too many hairs in one area, as such 




HAND ELECTRODE. 

operations have a tendency to leave more cicatricial tis- 
sue than those selected from different parts. After 
completing the operation, which consists of removing 
from twenty-five to fifty hairs at each sitting, the sur- 
face may be covered with oxide of zinc ointment, or 
cold cream. In a few days, as soon as the skin is de- 
void of soreness, you may operate again. 

FALLING HAIR AND BALDNESS. 

Remedies for the treatment of falling hair and bald- 
ness, constitute a greater demand than all cosmetic 
preparations, and nearly every woman has some "favor- 
ite" hair grower. 



264 THE HAIR 

Selecting remedies to promote the growth of hair 
will depend largely upon the condition we have to deal 
with, whether the scalp is dry or oily; dandruff and 
"itching" of the scalp are always preceded by premature 
falling hair, but without going into details regarding the 
pathology of falling hair, I will give a typical formulae 
for these conditions, and state what we may expect to 
accomplish from such medications, before attempting to 
stimulate the growth of hair. The scalp should be 
thoroughly cleansed with tar soap. I prefer Packer's 
or an egg shampoo followed by a bath in 1.2O00 bi- 
chloride of mercury solution. This gives us a clean 
and aseptic scalp to work upon. Than the following 
hair tonics may be applied, according to the condition 
of the scalp. 

TONIC FOR DRY SCALP. 
Seborrhoea Sissa. 
B Resorcine 3 dr. 

Fl. ex. pilocarpus . . . . . . 3 dr. 

Tinct. cantharides . , 4 dr. 

Glycerine 4 dr. 

Spirit lavender comp 4 dr. 

Castor oil 1 dr. 

Bay rum, q. s: 1 pt. 

(Mix the castor oil with the bay rum, add the other 
ingredients, and apply to the scalp with a tooth brush, 
before retiring. In resuming the therapeutic action of 
the above formula, we find resorcine is added to nearly 
all hair tonics for its antiseptic influence. It is closely 
allied to carbolic acid, but has the advantage over the 
latter, as it is odorless, more soluble, and non-irritant. 
Pilocarpus is added for its stimulating influence upon 
the glands of the scalp, to encourage their normal secre- 
tions ; tinct. cantharides is incorporated for its counter- 
irritant effect to stimulate the circulation and activity 
of the tissues of the scalp. Castor oil provides a tem- 
porary lubricant to the scalp and hair, and is the prin- 
cipal constituent of all "brilliantines," as it makes the 
hair appear rich and glossy. Glycerine has a similar 



THE HAIR 265 

effect, and is also a mild stimulant to the scalp. The 
spirits of lavender comp., and bay rum form the men- 
struum, while this is the most excellent tonic for the 
dry scalp, we have absolutely another condition to deal 
with in the oily scalp — seborrhcea oleosa — in this con- 
dition the scalp secretes an over-abundance of oily mat- 
ter, and instead of attempting to stimulate the gland- 
ular secretions of the skin, by the use of pilocarpus, our 
treatment is directed to check them by astringents; thus 
the formula would be changed as follows : 

TONIC FOR OILY SCALP. 

Seborrhoea Oleosa. 
IJ Resorcine 3 dr. 

Tinct. Cantharides 3 dr. 

Lead acetate 1 dr. 

Sulphur precipitated 3 dr. 

Glycerine . 4 dr. 

Bay rum, q. s 1 pt. 

Apply to *he scalp with tooth-brush, before retiring. 
In this formula, we have substituted the lead and sul- 
phur for the pilocarpus, because of their astringent and 
germicidal influence. 

In using either of the above tonics, the hair and 
scalp should be thoroughly shampooed with a beaten 
egg, which is followed by a thorough bath with Pack- 
er's tar soap. 

HAIR DYES. 

It is doubtful if the average man or woman has 
accepted kindly the familiar "golden text" from the 
bible, "the hoary head is the crown of glory.'' I am 
more inclined to believe that the poet has described 
our attitude towards hoary hair in the following verse : 
And thou bast come at last, ' 
Thou baleful issue of the buried yeais; 

Sad fruitage cf the past, 
Root nurtured in h loam of hopes and fears ; 
I hail thee, but I hate thee, lurking there 
Thou first gray hair! 



266 THE HAIR 

In order to practice deception upon Father Time, 
hair dyes have always figured conspicuously with the 
most ancient and modern cosmetic requisites. There 
are two ways in which the hair may be caused to 
change its color or shade: the first is by simple stains, 
and the second is by chemical action. One of the sim- 
plest and most convenient ways of staining the hair a 
beautiful brown is to use a strong infusion of black t ea. 
in the early stages when the hair is just commencing 
to turn gray. This offers a most excellent means of 
maintaining its youthful appearance, and is the method 
used at most hair establishments in coloring switches 
to match natural hair. Sage is usedfor the same pur- 
pose, and no doubt enters largely in that much adver- 
tised nostrum, "Ozark Herbs." Where stronger stains 
are required green walnut hulls are used, as in the 
following: 

I£ Green walnut hulls 10 dr. 

Alum . . ' 2 dr. 

Resorcine 1 dr. 

Glycerine 2 oz. 

Water, q. s 1 pt. 

Grate the hulls and boil slowly in the pint of water 
for thirty minutes, strain, and add the other ingredi- 
ents, and sufficient water to make -from ten to sixteen 
ounces, according to the strength desired. This makes, 
approximately, the same preparation as the much adver- 
tised "Walnuta" hair dye. Before using this, or any 
of the chemical dyes, it is always best to test the shade 
you desire by the hair combings, and the hair should 
always be thoroughly washed with soap and water, con- 
taining soda, before using any dye to remove all grease. 
It is best applied with a tooth brush and fine toothed 
comb, to protect the scalp, parting the hair in sections 
at the scalp, and working the dye to the end of the 
hair. 

Hair dyes proper depend upon their chemical action 
with the organic substance of the hair; thus peroxide 
of hydrogen in 10 to 20 percent, or stronger solutions, 



THE HAIR 267 

removes the pigment matter from the hair, and gives it 
a golden color. A 10 to 20 percent solution of potas- 
sium permanganate will give the hair a brown tint. 
Resorcine will give it the red or "Zaza shade." 

PYROGALLIC ACID AND SILVER DYE, 
Black and Brown. 

These dyes are prepared in two bottles, numbered 1 
and 2. After thoroughly washing and drying the hair, 
No. 1 is applied with a tooth brush, taking care not to 
wet the scalp, which is protected with a fine toothed 
comb; when partially dry apply No. 2 in the same 
manner, using another brush. The following are the 
two formulas used: 

No. 1. 

5 Pyrogallic acid 1 dr. 

Alcohol 4 dr. 

Water dis. . * . 4 oz. 

No. 2. 

Tf> Silver nitrate . . . 1 dr. 

Water distilled 4 dr. 

Ammonia water q. s. 

Dissolve the silver nitrate in the water, and gradu- 
ally add the ammonia water, stirring constantly until 
the brown turbidity produced has vanished and the 
liquid appears colorless. Then add enough distilled 
water to make one ounce. 

A large excess of ammonia tends to produce a 
brownish dye. Various shades of brown may be ob- 
tained bv increasing the amount of water in the silver 
solution. Always remember to thoroughly wash the 
hair before ^veing it, with water containing sodium 
carbonate; we 11 rinsed with clear water, and dried, and 
the dye effect is better if the hair is kept moist as long 
as possible after being dyed. It may be wrapped in a 
turban of cloth, or better still, in the rubber bathing 
cap. 



268 CHIROPODY 



Chiropody 



Chiropody bears about the same relation to the 
medical profession today as dentistry did half a cen- 
tury ago; as it was only a few generations ago that 
physicians deemed dentistry a minor subject, unworthy 
of any special attention or surgical skill, other than the 
extraction of teeth, for the relief of pain ; yet dentistry, 
as a branch of the medical art, has developed into one 
of the worthy and respected professions. If we would 
only stop to consider that ills caused from ailments of 
the feet are quite equal to those of the mouth, as nine 
people out of every ten are afflicted with some disease 
or discomfort in this part of their anatomy, we would 
realize that it is time physicians should give this sub- 
ject more than a passing notice. Through the neglect 
of this specialty Chiropody has, unfortunately, fallen 
into the hands of many unskilled ''corn whittlers," who 
style themselves "Chiropodists." While many- of these 
embryo surgeons possess more than ordinary skill in 
treating disorders of the feet, the .majority of them 
have little, or no knowledge of antiseptics, and other 
surgical dressings, and these operations are often fol- 
lowed with the most serious results. 

I, personally, have no use for trie physician who 
considers it beneath his dignity to treat the feet, or any 
other part of the body, if he possesses skill to relieve 
pain, and alleviate suffering. Chiropody certainly 
offers him a large field for his usefulness. 

However trivial the maladies of the feet may appear, 
and however they may be sneered at, and considered 
beneath the dignity of medical science, they neverthe- 
less, demand careful attention; the physician will be 
amply repaid for his services, or for any information he 
may contribute to the ease and comfort of mankind. 



CHIROPODY . . , 269 

THT CAUSE OF CORNS. 

In treating corns, as a rule, we have only the four 
outer layers of the skin to deal with, (the epidermis) ; 
the true skin is seldom affected, unless it is involved 
in the sloughing process of suppuration. 'Corns and 
callosities appearing upon the feet are caused either by 
pressure or friction, usually due to the improper selec- 
tion of footwear. There are two forms of shoes which 
should be condemned — the high heels and narrow toes. 
The erroneous idea many women possess, of trying to 
ape the aristocratic Chinese women, by attempting to 
make their feet appear small, from the use of these 
shoes, has offered more labor for the chiropodist than 
any other cause. These shoes force the feet forward, 
compelling pressure between the toes, to a state of fric- 
tion, and produce corns, both between the toes, and 
upon the top surface of the prominent articulation; 
while tight, narrow-toed shoes induce corns by pres- 
sure. Too loose, and poorly fitting shoes, produce corns 
and callous hardening by irritation. This is the prin- 
cipal cause of all callosities on the heel and bottom 
surface of the foot. 

There has been much said regarding the pathological 
formation of corns. Most observers are in accord, how- 
ever, that the pressure on prominent articular surfaces 
causes an exudation of lymph which coagulates under 
the epidermis, and through its inspissations, forms the 
substances of corns. Corns seldom involve the true 
skin, but their penetration into the cutis vera, and the 
pressure upon the nerve filaments of the papillae, cause 
the annoying pain connected with these growths. Sir 
Erasmus Wilson says: 

"The new position of the formative organ of the 
epidermis, namely, the corneum, occasions an altera- 
tion in the direction of the strata of the epidermis. The 
strata formed within the cup assumes, naturally, the 
cup shape, and as they rise to the surface, present the 



2?0 CHIROPODY 

broken edges of a cup, with a small central mass or 
nucleus, (the eye of the corn), suggesting the idea of 
vertical fibres rising to the surface, and the suggestion 
is increased by the broken edge of the epidermis that 
corresponds with the border of the cup. The fibrous 
appearance of the center of the device has suggested 
the idea of roots, and the central cup-formed mass of 
hard and condensed cuticle has been regarded as the 
core or root of the corn. 

The use of the word root in the description of corns 
has implanted the idea that they grow like a vegetable, 
and in order to eradicate the diculty, this filament must 
be destroyed ; this is an erroneous conception, which 
has often led to great disappointment to the sufferer. 
Corns have no roots, and are only embedded in the 
sensitive structures of the true skin ; they will always 
reappear if their primary cause is not removed, namely, 
pressure or friction. 

CLASSIFICATION OF CORNS. 

Although most corns are similar in structure, they 
present varieties, according to the parts upon which 
they are formed, or the tissue which becomes involved. 
We, therefore, find seven distinct varieties of these 
growths, namely : hard, soft, festered, nervo-vascular, 
laminated and fibrous corns, and callosities of these. 
The hard corns are of the most frequent occurrence. 
A favorite seat for these corns is on the outer surface 
of the little toe, and the inner flap of the great toe, 
although they may occur on any part of the foot where 
extreme pressure is applied. These corns are deep- 
seated and very painful. 

Soft Corns are somewhat different in nature from 
hard corns, and are always located between the toes, 
and are supposed to be formed by the perspiration col- 
lecting between the toes, and the pressure of one toe 
against the joint of another. They are not deep 
seated, or as painful as hard corns, the pain being of 
a stinging character. 



CHIROPODY 



271 



Festered Corns are due to pressure, forcing the toes 
out of their natural position, which frequently occurs 
in ''breaking in" a new pair of shoes. The first indi- 
cation of this complaint is redness, swelling and in- 
flammation of the afflicted part, which may involve the 
entire toe. These corns can only be relieved and cured 
by properly adjusting the footwear, to remove the 
pressure from the affected surface. 

Nervo-Vascular Corns are generally found in deli- 
cately skinned persons, with fair complexion ; their 
skin being more vesicular than usual, disposes to in- 
flammatory action, even after moderate pressure. These 
corns are also more frequently found in persons ad- 
vanced in life, with weak vitality. In the early stages 




Fiench Heel Cramp. Hard and Soft Corns 



they are intensely inflamed; this irritation subsides in 
a few days, if the pressure from the shoe is avoided. 
After the acute inflammation has subsided the corns 
can be carefully dissected away, and an application of 
nitrate of silver applied. 

Vascular Corns have somewhat the appearance 
and character of warts ; they are spongy and vascular, 
but do not project much beyond the level of the skin. 
They contain red and black specks, which are sur- 
rounded by inflamed and swollen integument; they are 
very sensitive to the touch and attended with great 
pain. 



272 CHIROPODY 

Laminated Corns, also frequently referred to as 
black corns, are due to the formation of a blood cloth, 
or coagulated serum underneath the epidermis. These 
corns adhere very closely to the skin, and are, invar- 
iably formed like a shell. 

Fibrous Corns are more painful than the other 
varieties, but fortunately, they are less frequently met 
with, and their method of removal is the same as with 
the other varities. 

Callosities are not of the character of a corn, as 
there is no change in the integument, other than a 
thickening of the skin. This may appear on the hands, 
by sawing, or any other part of the body which is ex- 
posed to continuous friction. It is formed on the soles 
of the feet by the use to too loose shoes. These callo- 
sites rarely cause any trouble. If they should become 
inflamed, they can be removed by dissecting, the same 
as corns. 

THE TREATMENT OF CORNS. 

The treatment for corns consists of both medical 
and surgical measures. The first, and most important 
step to take, is prophylaxis — remove the cause. If the 
patient is wearing too tight, or too loose shoes, he 
should be advised regarding the proper adjustment of 
footwear. High heeled and pointed toed shoes should 
always be condemned ; also a too loosely fitting shoe. 

A description of the caustic remedies, used from 
time to time, for the removal of corns, would occupy 
the space of this book. Some have been too mild, and 
others too strong, but after years of experience, it has 
become an established fact that salicylic acid is the 
one remedy for the removal of corns. Salicylic acid is 
the happy medium ; it is neither too strong nor too 
mild. Its escharotic properties are strong enough to 
disintegrate the corn tissue, imbedded in the epidermis, 
without affecting the true skin. All the multitudinous 
corn cures on the market contain this remedy, in vari- 
ous per cents, as the active ingredient of their prepara- 



CHIROPODY 273 

tions. The component compounds are generally ac- 
companied by Cannabis Indica, or some other anodyne 
remedy, for the relief of pain, and dispensed in a base 
of collodion or cerate, as will be found in the following 
formula: 

LIEBIG'S CORN CURE. 

^ Ext. Cannabis Indica 5 parts. 

Salicylic acid 30 parts. 

Collodion 240 parts. 

Mix until dissolved. Apply with a camel's hair 
brush, for consecutive nights and mornings, to form a 
thick coating. The collodion protects the corn from 
irritation and rubbing, while the extract of Cannabis 
Indica acts as an anodyne, and the salicylic acid dis- 
solves and disintegrates the corn. 

HANSON'S MAGIC CORN CURE. . 

I£ Salicylic acid 1 dr. 

Simple cerate loz. 

Mix intimately. 

KOHLER'S ONE NIGHT CORN CURE, 

^ Salicylic acid 1 dr. 

Lard 3 dr. 

DIAMOND CORN PLASTERS. 

One of the most convenient, and cleverly devised, 
treatments is known as the "Diamond Corn Plasters, " 
which are made as follows : An adhesive plaster is 
made by melting equal parts of resin and balsam of fir 
together ; while warm, spread on cambric cloth, cut in 
diamond shape. When worn, a circular pad, with a 
disc in the center, should be placed in the middle of 
the diamond, and the central disc filled with the fol- 
lowing mixture : 

I£ Ext. Cannabis Indica 1 dr. 

Resin 3 dr. 

Balsam of fir . 2y 2 dr. 

Salicylic acid . 5 dr. 



274 CHIROPODY 

Melt the resin and balsam of fir together, then stir 
in the Cannabis Indica and salicylic acid. 

In applying these plasters, the central medicated disc 
should be placed directly over the corn, and the pointed 
ends of the adhesive plaster wound around the toe, to 
form the attachment. 

The surgical treatment of corns is of great impor- 
tance, as instant relief can be obtained by their imme- 
diate removal, with the knife. To successfully detach 
a corn, the operator has to exercise some judgment 
concerning the different forms of corns. The principal 
object in view is to remove all the corn tissue. 

In dissecting away a corn or callosity, the operator 
should commence at the edge of the corn, and detach 
from the subjacent tissue every portion of the extrane- 
ous substances there inbedded, including the, so-called, 
eye of the corn. Great caution should be exercised not 
to cut into the true skin, as this will produce bleeding, 
which can be avoided if the operator is careful. If the 
corn is an exceptionally sensitive growth, a few drops 
of cocaine solution can be injected beneath the corn, 
and the operation rendered painless. After the corn has 
been successfully removed, the denuded surface should 
be dusted with aristol europhen, or some other anti- 
septic powder, over which a thin .layer of absorbent 
cotton is placed, and held in position with adhesive 
plaster, which will diffuse the pressure of the foot, and 
assist the healing process. Some chiropodists prefer to 
cauterize the surface with nitrate of silver, with a view 
of permanently destroying the growth. 

Bunions are due to a malformation of the foot, 
which is usually limited to a morbid condition of the 
internal lateral ligament of the metatarso-phalangeal 
articulation of the great toe, of the superimposed cellu- 
lar tissue and integument, and the development of a 
bursa produced by pressure and irritation. When the 
bone has become affected, it is only secondarily, and 
must be viewed as a complication, and not as a disease. 
The pain arising from a bunion differs from a corn, as 
it is of a more aching character. Although a radical 



CHIROPODY 275 

cure for bunions can seldom be promised, there are 
many palliative treatments, which can be applied, and 
relief from suffering inconvenience is afforded by proper 
treatment. The most beneficial local remedies are cold 
water dressings, and linseed meal and boracic lint poul- 
tices. If the bursa becomes too annoying, it may be 
dissected away, but such operations always result in 
ankelosis. 

Ingrown Toe Nail is of very frequent occurrence, 
and is usually found upon the outside surface of the 
great toe. This condition is due to wearing shoes 
which are not long enough for the feet, or the foot is 
thrown forward, as with high heeled shoes, impinging 
the great toe. 




TREATMENT FOR INGROWING TOE NAIL. 

The following method of medicated treatment is 
the most satisfactory, and will cure "at least ninty per 
cent of all cases: The flesh should be pulled away 
from the nail, at the irritating side, by a strip of ad- 
hesive plaster, which is wrapped around the toe, to 
draw the cutaneous border away from the nail. The 
irritating surface should now be thoroughly cleansed 
with peroxide of hydrogen. The exposed fissure should 
be packed with a copious application of dried alum, and 
thoroughly packed in with an absorbent cotton tam- 
pion, over which the second strip of adhesive plaster 
may be wrapped entirely around the toe. The accom- 
panying cut illustrates the method of packing and 
applying the tension strip, which is now ready for the 
final strip around the toe. 

This simple method, if properly conducted, will give 
most excellent results;-' by repeating this application for 



276 



CHIROPODY 



a few days the suppuration rapidly dries up, and pain 
and discomfort are relieved almost at once. 

The surgical treatment consists of complete removal 
of that portion of the nail imbedded in the flesh. The 
operation can be made* painless by the use of an injec- 
tion of cocaine alongside the parts to be operated upon, 
and the Esmarch haemostatic bandage should be ap- 
plied above the operative surface, to check the flow of 
blood. With a pair of sharp pointed scissors the nail 
is cut its full length ; the offending portion should then 
be grasped with a strong pair of dressing forceps, and 
with a slight twist outwards, removed from the matrix, 
and an antiseptic dressing applied. 





.nd 2, Operation for ingrown toe nai 




3, Onyehis. 



HORNY GROWTHS, AND UNGUAL 
EXOSTOSIS. 

Sometimes appear at the outer margin of the great 
toe, and create great suffering; the only method of 
treatment is complete excision, and an antiseptic dress- 
ing. 

Onychis is an inflammation of the matrix of the 
nail, causing ulceration of the surrounding tissues, and 
may be caused either by injury or constitutional dis- 
turbances. The simpler forms commence with the 
usual signs of inflammation around the nail, which be- 
comes red, painful and swollen. Mild cases can be 
cured by cauterizing the parts with nitrate of silver, or 
other caustics. Other cases will require the complete 
removal of the nail by the use of the knife, allowing 
the wound to heal by granulation. 



CHIROPODY 



277 



Hypersidrosis, or excessive sweating, is a very an- 
noying condition, which Chiropodists are requested to 
treat. Patients thus afflicted should wash their feet 
and change their stockings daily, and provide good 
ventilation in their shoes. The inside of their stockings 
should be dusted with boracic acid, and the application 
of the following formula, each night before retiring, 
will be found beneficial: 

If Tannic acid 3 dr. 

Alcohol . '. . 6 dr. 




UNGUAL EXOSTOSIS. 




Bromidrasis, or obnoxious smelling feet, is not of 
uncommon occurrence, and many husbands and 1 wives 
have been requested to sleep alone, owing to the odor 
emanating from this condition. The following formula 
will always give prompt relief: 

]$ Bismuth su'bnitrate ......... 1 oz. 

Potass, permanganate . . V/2 ozs. 

Rice powder 2 oz. 

Sprinkle liberally on the feet, and in the stockings 
and shoes. This application can also be applied to the 
axillae, and other parts of the body, for the same con- 
dition. 

Chilblain is a local non-suppurative hyperemia, or 
cellulo dermatitis, induced by exposure to cold, and can 
readily be cured by the use of equal parts of Peruvian 
bark and castor oil. 



273 GYNAECOLOGY 



Gynaecology 

Non-Surgical. 



Of all the diseases which have ottered the office spe- 
cialists a fertile field, the ailments peculiar to women 
perhaps head the list; and there are very few women 
who pass through the span of life without requiring 
the services of the physician at some period, for the 
treatment of diseases peculiar to her sex, and the prev- 
alence of these conditions are, apparently, increasing to 
an appalling extent. Visit any hospital or sanitarium 
in the country and you will find at least twenty-five 
per cent of the patients are gynaecological cases. 

When God created woman from the rib of man, he 
evidently intended she would be his masterpiece, an 
improvement to man, or man modified and perfected, 
yet, in his last crowning handiwork, he has rendered 
her doubly susceptible to a class of diseases and injuri- 
ous influences, from which the other sex is entirely 
exempt; therefore, from puberty to the menopause may 
be considered the critical period of her life. During 
these thirty or more years the functional derangements, 
physiological changes, and pathological conditions con- 
stitute the greatest number of any classified diseases 
the physician is called upon to treat. 

Surgery, of later years, has entered into gynaeco- 
logical practice to such an enormous extent that now- 
adays it is, apparently, a fashion, other than a neces- 
sity. Out of idle curiosity I recently requested a fash- 
ionable club lady to ''invoice'' the members of her club, 
to ascertain the percentage who had undergone an oper- 
ation ; her report was, that of the eighteen members 
present, fifteen had been surgically treated for the dis- 
eases peculiar to their sex ; of these, seven were lap- 



GYNAECOLOGY 279 

arotomies. She also stated that "this proved to be 
surgical day at the club," all discussing their ailments 
and operations, and the remaining three, (who were not 
victims of the knife), were apparently jealous because 
they had not experienced the pleasure (?) of a surgical 
operation. This is a fair illustration of the extent of 
gynaecological surgery in our cities. In the country 
this practice is not carried on to such an extent. 

I do not wish to be understood as condemning con- 
servative surgical measures, for there is no class of 
ailments in .which surgery has served a more noble 
purpose than in the diseases of women, but these spe- 
cial diseases have also offered such an inviting field to 
the "surgical grafter," that many highly respected 
Gynaecologists have created a breach in moral and med- 
ical ethics by advising surgery for the sole purpose of 
attempting to establish their reputations as surgeons, 
and fatten their purse. 

These operations have not only been confined to 
ovariotomies for the prevention of conception, but in a 
large class of diseases, in which non-surgical means 
would have produced better results. I will, therefore, 
discuss some of the therapeutic measures which have 
rendered me indispensable service in the non-surgical 
treatment of the diseases of women. 

CLASSIFICATION OF TREATMENTS. 

The non-surgical treatment of. the diseases of wo- 
men incorporates every means other than the knife ; 
we therefore, have all the physiologic methods dis- 
cussed in the preceding pages, combined with the med- 
icinal measures at our command. These may be 
divided into internal medications, or medicines taken 
by the mouth. Extra-uterine medication, or medicines 
used by absorption by applications to the vaginal canal, 
at the mouth of the uterus, etc., intra-uterine medica- 
tion by application to the uterine canal and cavity. 

These three methods of medication, either used 
singly or combined, incorporate the means generally 
used by physicians for alleviating suffering and curing 



280 GYNAECOLOGY 

the diseases peculiar to women. It is, therefore, well 
to have a correct understanding of these therapeutic 
measures. 

INTERNAL MEDICATION. 

Of the remedies which interest us the most, for the 
internal medications for the diseases of women, come 
under the classification of uterine tonics, alteratives 
and analgesics. It is beyond the scope of this book to 
discuss in detail all the remedies offered in this class. 
I will, therefore, give only two formulas, which are dis- 
pensed in tablet form, that have been of much service 
to me, and will be referred to later. 

UTERINE TONIC. 

Each tablet contains — 

Ext. Viburnum prun 1 gr.. 

Ext. Viburnum opul , 1 gr. 

Ext. Star grass y> gr. 

Ext. Squaw vine Yi gr. 

Ext. Helonias y 2 gr. 

Caulophyllin %. gr. 

Directions — A tablet four or more times a day ,as 
required. 

UTERINE TONIC— SEDATIVE AND 
ALTERATIVE. 

An exceptionally efficient combination in Dysmen- 
orrhcea, Ovarian neuralgia, Uterine congestion, and all 
painful conditions of the pelvic organs, associated with 
anaemia and constipation. 

Blaud's Mass 1 gr. 

Ex. Black Haw 1 gr. 

Ex. Blk. Cohosh 1 gr. 

Ex. Hydrastis y 2 gr. 

Euonymin y 2 gr. 

Apiol y 2 gr. 

Ex. Gelsemium % gr. 

Strych. Sulph 1/120 gr. 

Aloin V 10 ^ 1 "- 

One or two tablets, three times a dav. 



GYNAECOLOGY 281 

VAGINAL DOUCH THERAPY. 

That the external bath was succeeded at a very 
early period by the internal bath or douch, through the 
principal orifices of the body, the rectum and the vag- 
ina, is authenticated by one of the ablest early histor- 
ical writers on bathing — Dr. John Bell — who states that 
women of the orient devised apparatus of dried skins, 
and bladders of animals, with crude wood or bone noz- 
zles, by the use of which they could take the vaginal 
douch. There was no improvement upon devices for 
the vaginal douch, until the utilization of rubber in 
commerce. Since the introduction of rubber, there 
have been many styles of douch syringes; the old style 
double tube, hand ball syringe, was the first to become 
popular. This was followed by the fountain syringe; 
both are deficient in their purpose, when we consider 
the anatomical construction of the parts, and the ther- 
apeutic uses of the vaginal douch. In conducting the 
vaginal douch for therapeutic purposes, there are many 
things to be considered. The first and most important, 
is a properly constructed douch syringe; the second, is 
the technique of the douch to accomplish its greatest 
therapeutic results ; third, the use of the vaginal douch 
as a sanitary, hygienic and prophylactic measure; 
fourth ,its utilization as a curative and restorative 
means in the treatment of many diseases peculiar to 
women. 

In selecting a syringe to accomplish the best results 
from vaginal douch therapy, there are many essential 
things to remember. The first, and principal object 
of the vaginal douch is cleanliness ; to accomplish this, 
the syringe should be so constructed as to wash out 
and not in. This brings us to the point of considering 
the anatomical construction of the vaginal walls, the 
lining membranes of which are arranged in transverse 
folds and pockets, instead of longitudinal, as is gener- 
ally believed by those who are not familiar with the 
minute anatomy. It is these transverse folds and pock- 
ets which naturally detain the escape of effete matter; 



282 GYNAECOLOGY 

to thoroughly eliminate these accumulating impurities 
requires a douch current, which will be ejected from 
the syringe in a transverse rotary, or whirling move- 
ment. The pouch which surrounds the cervix, known 
as the cul-de-sac, is also another favorite seat in which 
accumulation, of effete matter accomplishes its destruc- 
tice influence in breeding pathological conditions, and 
the only way to reach this part of the female genera- 
tive tract is by distending the walls. Another very 
important thing to be considered in the mechanical con- 
struction of a douch syringe is its ability to maintain 
hot, cold or medicated solutions against the expanded 
walls of the vagina for a definite length of time ; as all 
solutions are absorbed and receive their greatest thera- 
peutic influence more rapidly with the walls expanded 
than they will while in a relaxed state. It will thus 
be seen that the only way to properly conduct a vaginal 
douch will depend upon three principal things, namely : 
Complete dilatation of the vaginal walls, a transverse 
rotary movement of the douch current, to dislodge and 
remove any and all destructive elements, and to retain 
the expansion of the vaginal walls long enough to allow 
the hot, cold or medicated solution to have a prolonged 
influence, if desired. While the double tube ball syringe 
has fallen into the relics of antiquity, the fountain 
syringe is fast following in its wake, as the only results 
accomplished by either of these syringes is a super- 
ficial flushing, which is sure to leave remnants of im- 
purities, with their contaminative influence. 

There is one syringe offered the medical profession, 
which can be unhesitatingly endorsed and recom- 
mended, as fulfilling all the requirements mentioned 
above. This is known as the "Irrigating Syringe." 
This syringe is so constructed, by a special device at 
the tip, that the douch current will be ejected in a 
rotary movement, which will immediately dislodge and 
remove all effete matter from the walls and transverse 
folds of the vaginal canal, from the cul-de-sac to the 
labio-vaginal orifice. At the base of the nozzle is a 



GYNAECOLOGY 283 

soft rubber adjustable shield, which anatomically con- 
forms to the parts, without injuring their delicate and 
sensitive structure. This shield prevents the escape of 
water, and allows the syringe to be used in either the 
recumbent, sitting or standing position, as may be re- 
quired at times, without soiling the clothing. This de- 
vice also allows complete expansion of the vaginal 
walls, and the prolonged effect of the douch solution, 
when desired. The bulb, which is also the container 
for the douch solution, has a capacity of nine fluid 
ounces, and, although smaller in volume than the foun- 
tain syringe, the douch solution accomplishes greater 
results, as it covers every particle of space within the 
vaginal cavity, which would be impossible to do with 
a four-gallon solution and the ordinary nozzle of a 
fountain syringe, that has to be continually moved from 
place to place, being likewise inconvenient, deficient 
and ineffective in its purpose and results. 'While the 
use of the fountain syringe generally requires the sit- 
ting position and a receptacle, this syringe may be used 
in any position, as the douch solution is drawn back 
into the rubber bulb t>y simply releasing the pressure 
upon the bulb. This syringe is also so constructed 
that it may be easily taken apart and rendered antisep- 
tic, at all times, with little or no inconvenience ; in fact 
it is 'the only ideal and scientifically constructed syringe, 
in present use, which is based upon the anatomical con- 
formation of the parts to conduct the technique of the 
vaginal douch. Our attention is now called to what 
conditions, class of ailments or pathological changes 
can "Vaginal Douch Therapy" be utilized to its great- 
est advantage. The first requisite is personal clean- 
liness; it was John Wesley who said, "Cleanliness is 
indeed next to Godliness," and in no part of the female 
organism is the axiom of truth from this great divine 
better exemplified than in the use of the vaginal douch, 
as a hygienic and prophylactic principle; for the propa- 
gation of weakness and disease often have their origin 
in the neglect of cleanliness of the vaginal canal, and 



2S4 GYNAECOLOGY 

the cause of the prevalence of ill-health, among many 
women, may be traced directly or indirectly to a de- 
ficiency in knowledge of the value of the vaginal 
douch. It is the general belief among many women 
that the vaginal douch is only necessary in diseased 
conditions; this is a great mistake, as the vaginal douch 
is the one principal means in our possession of obtain- 
ing and maintaining health to this generative tract, and 
requires the same precaution toward cleanliness, only 
in a greater degree, than any part of her body, for at 
this age, the internal, as well as the external bath, will 
bear fruit in the health of the future generation. I feel 
justified in stating that fully fifty per cent of the weak- 
nesses and diseases peculiar to women could have been 
obviated by the timely use of the vaginal douch. To 
comprehend the value of the vaginal douch in the treat- 
ment of diseases peculiar to women, we must know the 
value of tepid, hot, cold and medicated douch solutions; 
also their therapeutic relation and value in the different 
pathological conditions. 

In considering the thermic influence of douch solu- 
tions we must always bear in mind that cold contracts 
the blood vessels, and retards the circulatory functions, 
while heat increases the circulation by dilating the 
blood vessels, and increasing the progress of blood 
currents. We, therefore, find that the cold douch has 
such a limited field of usefulness that it is hardly 
worthy of mention ; this is also true of the tepid douch, 
as there is no reaction, and neutral results are only 
expected for cleanliness ; therefore, the hot, prolonged 
vaginal, douch, and the medicated vaginal douch, are 
of the greatest value. 

THE TECHNIQUE OF VAGINAL DOUCH 
THERAPY. 

This will depend upon the functional or patholog- 
ical condition we have to contend with, and whether 
we ^wish the douch for its immediate effects, as for 
cleanliness, or the prolonged effect for its thermic in- 



GYNAECOLOGY 285 

fluence, or the extra-uterine medication. Should we 
wish the douch for an immediate flushing for cleanli- 
ness, the standing or sitting position may be preferred 
by many, as the vaginal canal in this position is at an 
angle of about forty-five degrees, with the apex point- 
ing upwards, and the gravity of the douch solution 
would naturally fall downward with greater force upon 
withdrawing the syringe, and be more thorough in its 
purpose. If we wish a prolonged or medicated douch, 
the recumbent position is preferable, as the vaginal 
canal in this position is placed at an angle of forty-five 
degrees, with the apex downward, and the gravity of 
the water, together with the force from the pressure 
upon the bulb, and the prevention of the escape of the 
douch solution, by the protective labial shield will allow 
the thermic or medicated solution to remain for an in- 
definite length of time, which is one of the many ad- 
vantages of the irrigating syringe. 

In order that we may logically comprehend the 
value of vaginal douch therapy, we must understand 
the technique of the different methods of applying the 
douch, and its therapeutic relation to disease. Un- 
doubtedly the most valuable douch in vaginal therapy 
is often referred to as the "prolonged vaginal thermic 
bath" ; this douch was made popular at Luxeuill, 
France, by a special apparatus whereby 20 to 2'5 gal- 
lons of water was used to maintain its thermic influ- 
ence. The same effect can be. produced by nine ounces 
of douch solution with this syringe. 

To obtain the full benefit of this bath the patient 
should be placed in the recumbent position, with the 
legs drawn up, and the hips elevated; the bulb of the 
syringe, previously filled with the douch solution, at a 
temperature of 110 to 113 degrees F; the nozzle is in- 
serted into the vagina until the protective rubber shield 
is adjusted firmly against the labio-vaginal orifice, to 
prevent the escape of the solution ; pressure is now 
made, gently, upon the bulb, until the vagina is dis- 
tended to its full capacity ; the bulb is now relaxed, and 
the solution is withdrawn back into the syringe. The 



286 



GYNAECOLOGY 



operation should be repeated several times, as the dila- 
tion and relaxation of the vaginal walls have a very 
stimulating effect. Fresh douch solutions may be used 
each time if desired, although it is not necessary. This 
is the treatment, par excellence, for many forms of 
pelvic affections. It will relieve pain in this cavity, as 
a rule, almost instantly; any form of congestion and 
inflammation are greatly benefited, as it increases the 
activity of the circulation, and removes the inflamma- 
tory exudates. Its therapeutic influence is fully one 




PROLONGED VIGANAL, THERMIC BATH. 



hundred percent, greater than hot fomentations, and the 
use of the water bottle, to the external surface, as the 
vaginal douch brings the thermic effect in more direct 
contact with the disease, and will penetrate the mucous 
membrane of the vagina more rapidly than it will the 
integument, and muscular layers of the external ab- 
dominal walls. 

Space will not allow me to give the technique of 
the value of this douch in all the different pathological 
conditions within the female pelvis, but in emphasizing 
its therapeutic value will say that pain, inflammation or 



GYNAECOLOGY 287 

congestion from any disease within the pelvis is greatly 
benefited by its use; this applies not only to the sur- 
face in which the douch solutions come in contact, but 
the penetration of heat will reach the deeper structures, 
as it will by no other means, and will be found useful 
as a therapeutic application in metritis, localized salpin- 
gitis, ovaritis, cystitis, pelvic peritonitis, diffuse lymph- 
angitis, without much swelling, etc. While these 
douches may not be the principal therapeutic curative 
process, they are especially valuable in preparing the 
way for other treatment. What is true in pathological 
conditions is equally true in functional disorders; its 
influence in curing amenorrhoea and dysmenorrhea is 
almost specific at times, while leucorrhoea is only a 
symptom of other diseases ; it abates the discharge by 
restoring health to the primary cause ; this is also true 
in menorrahage, metorragia, etc. In all cases there is 
a palliation of symptoms, and douches of this charac- 
ter may eliminate the presence of exudates and tume- 
factions of the adnexa, especially when used in con- 
junction with extra uterine and intra-uterine medica- 
tions. 

EXTRA-UTERINE MEDICATION. 

It is this method of treatment which is most uni- 
versally used by all physicians, and consists of any and 
all medications applied within the vaginal walls, which 
are utilized in the form of medicated douches, tampons 
and suppositories. The suppository medication is, by 
all. means, superior to any other form of extra-uterine 
treatment, as it has the following advantages : it may 
be used by the patient in the privacy of her home ; it 
allows complete and continuous medication while the 
organs are at rest, during the sleeping hours, (as the 
best time to use this medication is before retiring), and 
also allows direct medication to the diseased parts, in 
many conditions, and its absorption reacts to a thera- 
peutic advantage in the more remote diseases. We, 
therefore, find that with this form of treatment, we are 
able to reach the diseased conditions of all organs 



288 GYNAECOLOGY 

within the female pelvis. There are many medicines 
which have entered in this method of treatment, from 
time to time, but my experience, in the continuous use 
of the following medications, in their former and pres- 
ent modified form, has convinced me that it is superior 
to any other combination of medicinal agents, as a 
universal extra-uterine application. 

3J Elaterium 1-6 gr. 

Powd. Jequirity J4 gr. 

S. E. Belladonna y 2 gr. 

S. E. Hyoscyamus J^gr. 

S. E. Hamamelis ....... 1 gr. 

S. E. Calendula 1 gr. 

S. E. Thuja ......... 1 gr. 

Quinine and Urea hydrochloride . . ^ gr. 

Resorcine 2 gr. 

Zinc Sulphate 2 gr. 

Boric acid 4 gr. 

I have the above medications prepared in two forms: 
No. 1, in a base of cocoa-butter and slippery elm, and 
No. 2, in tablet form, resembling in shape the ordinary 
suppository. The former is used where quick action is 
required, as in dysmenorrhea, frequent and painful 
urination, the pain of cancer, etc. The latter is used 
where slow continuous medication may be required. 

In reviewing the above formula, one would naturally 
ask : why are so many remedies incorporated in a sin- 
gle suppository? I can only say that each has been 
added, from time to time, with a decided improvement, 
and as a general extra-uterine application, it would 
seem almost impossible to dispense with any one of 
them. We will, therefore, resume the therapeutic value 
of each remedy, and point out its specific purpose. 

Elaterium has long been recognized as one of the 
most efficient remedies we possess in extracting serum 
from the intestinal tract, and producing profuse watery 
discharges for the relief of ascites, anasarca, uremia and 
cerebral disorders. It has likewise been found to ex- 
tract serum from the pelvic cavity, when in constant 



GYNAECOLOGY 



289 



contact with the mucous membrane of the vagina, and 
accomplish the same results as glycerine tampons, used 
by nearly all physicians for the purpose of extracting 
serum, and thus relieving congestion and all inflamma- 
tory exudations. In fact, it is the pelvic antiphlogistic, 
"it bleeds, but saves the blood," and is a most valuable 
remedy in all inflammatory conditions, whether acute 
or chronic. 

Jequirity is a counter-irritant. The temporary 
effect is to create a mild inflammation, which subsides 




METHOD OP APPLYING EXTRA-UTERINE APPLICATION. 



and eliminates old inflammatory processes. This is 
generally controlled by the other remedies in this form- 
ula. The local use of belladonna is well understood 
by all physicians, as an antispasmodic and anodyne, 
and as a remedy to relieve pain, particularly of the pel- 
vic organs. Hyoscyamus is added for its anodyne 
effect. Hamamelis has a special influence over the 
veinous circulation, promotes the healing of erosions, 
ulcers, etc., and checks foul discharges, leucorrhcea and 



200 GYNAECOLOGY 

gonorrhoea. Thuja and calendula are also added to re- 
inforce this influence. Quinine and urea hydrochloride 
has made a wonderful improvement in the original 
formula, as by the use of this remedy, we have a most 
valuable and prolonged obtundent, and when this is ap- 
plied at the mouth of the womb, it will not only deaden 
the pain, which may be caused from dysmenorrhea or 
cancer, but placed between two other important organs 
the rectum and bladder, will give immediate relief to 
any irritating influence which may exist, while other 
therapeutic measures are being carried out for their 
permanent results. It is, therefore, of great value in 
relieving the pain from hemorrhoids, frequent and pain- 
ful urination, as a result of an irritable bladder. I have, 
also, added resorcine to this improved formula, as we 
derive all the benefit of carbolic acid in its non-irritat- 
ing form ; the zinc sulphate is utilized for its astringent 
properties and boric acid for its antiseptic influence. 

This formula may have the appearance of a "shot 
gun prescription," but it will hit the target, at rifle 
range, so often, that it has become one of my strongest 
armorments in fighting many pelvic diseases ; as mor- 
phine has the widest range of usefulness in general 
medicine, this covers the broadest area in pelvic disor- 
ders. By the application of this suppository we sup- 
press all pain and distress within the pelvis, nearly as 
rapidly as with a hypodermic injection of morphine, 
and while we are receiving- this temporary relief, we 
are removing inflammatory exudations, healing erosions 
and ulcerations, decreasing corrosive and purulent dis- 
charge, and permanently restoring these organs to their 
normal condition. 

The diseases in which this medication will be found 
valuable will be described under their respective class- 
ifications. 

INTRA-UTERINE MEDICATIONS. 

It is this form of uterine medication which has been 
commended and condemned more than any other means 
of gynaecological therapeutics ; although this otters 'us 



GYNAECOLOGY 291 

a valuable means of uterine treatment, it is not devoid 
of danger, when injudiciously used. The principal rea- 
son many physicians have failed to be successful with 
this treatment is not the quality of medicine used, but 
the quantity. They do not stop to realize that the nor- 
mal unimpregnated uterus, when extended to its full 
capacity, will only contain about ten or twelve minims, 
as graduated on the piston stem of a syringe, and any 
amount of medicine used, above this quantity, is either 
forced into the fallopian tubes, or perhaps through 
them, into the peritoneal cavity, where the most grave 
results may occur. This is the one principal thing 
which should always be remembered, and avoided, in 
all intra-uterine medications, as it is this state of 




♦ INTRA-UTERINE APPLICATOR. 

affairs which has made many physicians ignorantly 
condemn the method. Another very important thing 
to be considered is to have your instruments, and cer- 
vical canal aseptic, before entering the uterus proper, 
as any infection which may enter this cavity is sure to 
rapidly multiply, until the entire walls, including the 
fallopian tubes, and perhaps the peritoneum, will be in- 
volved; therefore, always be on the safe side, and avoid 
these unpleasant and grave obstacles; never inject over 
eight or ten minims, as is regulated by the graduate on 
the piston stem. 

In order to conduct intra-uterine medications suc- 
cessfully, it is necessary to have a suitable instrument. 
I prefer Baun's applicator, (or the one illustrated here), 
as this gives you full access ito the uterine cavity, and 
control of your medication. I can only condemn the 
glass pipett, which resembles the ordinary medicine 



292 GYNAECOLOGY 

dropper, as with this instrument you never have con- 
trol of your medicine, and almost always inject air into 
the cavity, producing "uterine colic." 



MEDICATIONS FOR INTRA-UTERINE 
TREATMENTS. 

Intra-uterine medication is divided into two sec- 
tions : the cervical canal, and the cavity of the organ ; 
treatment to the canal is by far in the greatest demand. 
Cocaine may be injected for anaesthetic purposes, in 
sensitive patients, to dilate the internal os; previous to 
dilation of the same, hemostatics and astringents may 
be used, where there is persistent and dangerous hem- 
orrhage. 

Menorrhagia and metorrhagia, dependent upon simple 
chronic congestion, and hyperplasia of the endome- 
trium, are successfully treated by these medications. 
Gonorrhoea, and other septic infections, extending to 
the uterine cavity, may also be successfully treated by 
direct application of appropriate medication to the 
affected area ; thus we find inflammation, congestion, 
infection and excessive hemorrhage' the principal indi- 
cations for intra-uterine medication. There are many 
remedies employed for this. Ichthyol alone, or in com- 
bination with other remedies, is one of the best med- 
ications ; it is not a caustic, but its action upon the tis- 
sues will contract the blood vessels, and reduce inflam- 
mation or congestion, and also has a soothing analgesic 
effect. Protargol is another valuable non-irritant as- 
tringent and antiseptic. Phenol iodatum, which con- 
sists of iodine 20 parts, glycerine 20 parts, and phenol 
80 parts, is also an excellent medication. These reme- 
dies either used singly, or in combination, constitute 
the greatest part of the medication used in office treat- 
ments. I use these in combination, in the following- 
formula, which I refer to as : 



GYNAECOLOGY 



293 



INTRA-UTERINE APPLICATION. 

~fy Protargol sat, sul. ... 2 dr. 

Phenol Iodatum 2 dr. 

Ichthyol . . . ... . . . . 4 dr. 

The above makes an indispensable preparation, as it 
has such a universal field of usefulness. 

TECHNIQUE OF INTRA-UTERINE 
MEDICATION. 

With the patient in the dorsal position, the spec- 
ulum is introduced, and the cervix is exposed and 
cleansed with an antiseptic solution, by the use of the 
dressing forceps. In commencing Intra-uterine med- 
ication, I always begin with the minimum quantity, to 



4 









METHOD OP APPLYING INTRA-UTERINE APPLICATION. 




see if it will be tolerated by the patient. Many women 
are very susceptible to this treatment, and it seems 
that any form of treatment within the uterine cavity 
will cause distress ; if the cervix alone is treated, there 
is never any complaint. The syringe is filled with the 
medication, and the tip pointed upwards, to force all 
the air out of the sound applicator, the set screw is 
adjusted on the piston stem, from five to ten minimum, 



S94 



GYNAECOLOGY 



and the applicator inserted to the point desired. Where 
gentle pressure is applied, to force out the medicine, 
and the instrument withdrawn, and a tampon of cot- 
ton applied to the os uterus, to absorb any superfluous 
medication which may come away later. This very 
simple means- of treatment is applicable in many cases 
which will be reviewed later. 

ELECTRIC UTERINE CURETTEMENT. 

The word curette is taken from the word "cure," 
meaning to cleanse, as applied in surgery to scoop or 
scrape. In office practice, electricity provides us with 
a more convenient and agreeable means of accomplish- 
ing the same results, without the aid of an assistant. 

GYXECIC 

SET OF 

ELECTRODES 

The specialist 
following this line 
of practice cannot 
afford to overlook 
the most complete 
assortment of ap- 
pliances adaptable 
to his work of- 
fered in this set. 

1 Set Goldspohn's 
Copper Intra- 
uterine Elec- 
trodes. 
Cataphoric 
Vaginal Elec- 
trode. 

1 Xeiswanger's 
Cervix Cata- 
aphoric Elec- 
trode. 

1 Hayes' Abdom- 
inal Electrode. 

1 Goelet's Bi-Po- 
lar Vaginal 
Electrode. 

1 Goelefs Zinc Di- 
lator Set. 

The object of curetting the uterus is to remove fungous 
degeneration, due to chronic endometritis. Retention 
of adherent placental villi, after miscarriage, etc. This 
is accomplished by the acid radical of the positive pole 
of the galvanic current, as it is by no other means. The 
technique of the operation is as follows : 

The patient is placed in the dorsal position, with a 
large electrode at her abdomen, attached to the nega- 




GYNAECOLOGY 



295 



tive pole ; a copper wire intra-uterine electrode is in- 
serted to the fundus of the uterus, attached to the pos- 
itive pole, and a current from 20 to 30 milliamperes is 
used, the electrode remaining about ten minutes. The 




1. Nieswanger's Cataphoric Electrode for Prostetic Urethr'e. 

2. Nieswang-er's Cataphoric Edectrode for Urethre. 

3. Nieswanger's Cataphoric Cervix Electrode. 

4. Fitz Hugh's Electrode for Erosions. 

5 and 6. Nieswanger's Copper Intra-Uterine Electrodes. 

current is now turned off, and the electrode is gently 
rotated until it is loosened, then it is withdrawn, and 
you will find it covered with the endometrium, and you 
have accomplished the same results as you would by 
the more bloody and inconvenient method of curretting 



296 GYNAECOLOGY 

the organ. This is repeated once or twice a week, 
until you have removed every particle of diseased tissue. 

THE COMBINED TREATMENT. 

By the use of the foregoing treatments, either used 
singly, or combined with the addition of electricity, 
and other physiologic methods, we are able to master 
many of the diseases of women, and "stay the hand of 
the surgeon." In order that the reader may readily 
comprehend the practical application of these different 
treatments, I will illustrate their use as applied to 
disease. 

FUNCTIONAL DISEASES OF WOMEN. 

From puberty to the menopause, the functional dis- 
eases of women offers a very important part in the 
practice of medicine, and there are very few women 
indeed, who pass this period of womanhood without 
experiencing some of the disorders of the menstrual 
phenomena. 

AMENORRHOEA. 

This condition is usually divided into two distinct 
classes. First, absence of the menses in girls who 
have never menstruated, and, second, suppressed men- 
struation where the flow having once been established 
fails to appear at the regular time. The absence of 
menstruation is a normal condition during pregnancy, 
and while the mother is nursing her child. 

Cause — Non-appearance of the menses is a frequent 
malady of girlhood, and may be due to a variety of 
causes, as lack of pure air, sunlight and proper exer- 
cise, improper and insufficient food. Anaemia, chlorosis, 
consumption or other wasting diseases ; malformation 
of the generative organs. Suppressed menstruation is 
most generally caused by exposure, such as getting the 
feet wet and body chilled. Intense excitement and ex- 
cessive study will cause it, but unless the excitement or 
study be constant, the system reacts healthily, and the 
trouble soon disappears. Acute diseases, such as ty- 



GYNAECOLOGY 



29 1 



phoid and scarlet fever, frequently suppress the menses, 
while displacements of the womb are among its causes. 
Symptoms are both local and general; some of the 
local symptoms are pain and a sensation of weight in 
pelvis ; dragging feeling in groins, weakness and bloat- 
ing of limbs. The general symptoms are such as lan- 
gour and debility, palpitation of the heart, difficult 
breathing, dizziness, shooting pains and cramps in the 
different parts of the body, and a long train of both 




INFANTILE UTERUS. 



bodily and mental symptoms may ensue, indicating a 
derangement of one of the most important organs of 
the body. One of the most singular results of sup- 
pressed menstruation is a condition known as Vicarious 
Menstruation, where the discharge develops at some 
other part of the body. This flow may occur at the 
regular time from the nose, gums, breasts, bladder, or 
from sores that may be on the body. 

Treatment of amenorrhoea requires the most dis- 
criminate care and attention to ascertain if possible, the 



298 GYNAECOLOGY 

exact cause. Careful study should be made of the hab- 
its of life and the mode of living. The patient should 
always have plenty of out-door exercise, such as walk- 
ing and riding in the open air, and indulge in such 
pastimes as conduce to good health and cheerfulness of 
mind and general tranquility of both mind and body. 

If due to anaemia or chlorosis, the uterine tonic with 
Blaud's mass, is of the greatest value. The prolonged 
vaginal douch and sitz bath, before retiring, will also 
be of great assistance in establishing a normal circula- 
tion in the organ. This should be followed by the 
extra-uterine application, and another vaginal douch in 
the morning. This treatment, continued for some time, 
will generally suffice in a large percentage of cases, 
where mechanical obstruction is not present; if by the 
use of the speculum is revealed the ''infantile'' or un- 
developed uterus, with congenital stenosis of the cer- 
vical canal, (see accompanying illustration), electricity 
is by far the best means of permanently dilating the 
canal, and assisting nature to develop this organ. The 
patient is placed in a dorsal position. A large, flat 
electrode, attached to the positive pole of the continu- 
ous current, is placed over the abdomen, and an olive 
shaped tip electrode, just about one size larger than 
the constriction, attached to the negative pole, is gently 
inserted into the uterine canal, until it meets the con- 
striction ; the current is now turned on, using from five 
to seven milliamperes, from five to ten minutes, inter- 
rupting it through the rheotome every two seconds, dur- 
ing the treatment; these interruptions produce a series 
of contractions and relaxations, (electric massage), and 
as a rule, the electrode will pass through the stricture; 
if it does not, repeat the operation, at the end of three 
days ; as a rule, however, the electrode will pass the 
stenosed part. At subsequent treatments larger elec- 
trodes may be used, until the canal is permanently 
dilated. This is our most successful treatment for all 
forms of stenosis of the uterine canal. If the uterus 
is undeveloped, as is the case illustrated here, our atten- 
tion is now called to the development of this organ. 



GYNAECOLOGY 299 

The switch is changed to the induced current, and 
with the electrode en situ, the rheotome is arranged in 
circuit for forty or sixty interruptions per minute, with 
the rheostat. We supply sufficient current to be agree- 
ably tolerated by the patient. Contractions should be 
distinctly felt, but not painful. These treatments 
should be continued from three to ten minutes. By 
continuing this treatment at intervals of three or four 
days, for a few weeks or months, we will succeed by 
this method, where other means have failed, as we 
have softened the indurated tissues, strengthened the 
muscular walls, dilated and increased the blood supply. 

DYSMENORRHOEA. 

There are four varieties of dysmenorrhea, which 
are classed as follows : First, obstructive ; second, con- 
gestive; third, neuralgic; and fourth, membraneous. 

The Cause and Symptoms — In the obstructive var- 
iety some organic impediment hinders the exit of the 
menstrual blood from the uterus, which gradually be- 
comes distended and painful from the spasmodic efforts 
to discharge the menstrual fluid. If these efforts prove 
successful there is an interval of relief. 

Flexions and versions of the uterus may occlude 
the canal of the neck of the organ, thus preventing the 
free escape of blood, causing intense suffering. In 
fact, this variety of dysmenorrhcea may be caused from 
any constricted or narrowed condition of the neck of 
the womb, whether it be the results of inflammation, 
congenital malformation, or the improper application 
of strong caustics used by incompetent physicians. 

In the congestive variety, the mucous membrane 
lining the womb seems to be the seat of irritation. The 
blood flows into the small blood vessels in greater 
abundance than is natural, these vessels become con- 
gested and enfeebled and so altered in their sensibility 
as to cause much excitement and pain. This variety 
may be associated with inflammation of the ovaries, 
peritoneum, bladder or other surrounding organs. Be- 
fore the flow is established there is always a feeling of 



300 GYNECOLOGY 

weight and heat in back or pelvis, headache, flushing 
of the face and some fever. These symptoms usually 
disappear after the discharge is thoroughly established. 

The neuralgic variety of dysmenorrhea is usually 
found in persons of a highly nervous temperament, who 
lead an indoor life, and are subject to neuralgia in other 
parts of the body, which at the time of menstruation 
instantaneously reflects upon the ovarian and uterine 
nerves, which seem to be the center of irritation and 
pain, and is at times so severe as to be almost unbear- 
able. I have seen a number of women who affirm that 
the severity of labor pains were not so great as those 
caused by this disease. The neuralgic pains fly along 
the tracks of the nerves to different organs, and may 
sometimes be transferred to the uterus or ovaries and 
sometimes elsewhere, producing nausea, headache and 
often delirium and convulsions. Ovarian dysmenor- 
rhea is applied to a class of cases which are associated 
with diseases of the ovaries. There is pain between the 
periods in the region of the ovaries, which is aggra- 
vated by pressure and exercise, and greatly increases at 
the time of menstruation. In the membranous variety 
of dysmenorrhcea the entire mucous membrane lining 
the cavity of the womb in consequence of some morbid 
process, is gradually detached and dispelled during 
menstruation. They are steady pains at the commence- 
ment of the menstrual flow, but they increase in vio- 
lence and become decidedly expulsive. The mouth of 
the womb gradually dilates and finally the membrane 
is forced out, attended by a slight flow of blood and 
an entire subsidence of pain. 

Treatment. — The treatment of dysmenorrhcea should 
consist of such means as will establish a normal and 
healthy circulation of blood in the parts, and thus 
relieve congestion and pain. For this purpose relief 
is obtained by means of using prolonged vaginal douch 
or hot sitz baths are of much benefit in relaxing the 
parts; this is followed by the extra-uterine application. 
This application alone will often give relief, nearly as 



GYNECOLOGY 301 

rapidly as a hypodermic injection of morphine, and 
may be applied every three hours, if necessary, during 
the period, with marked benefit, and, by continuing 
this treatment in conjunction with the uterine tonic, 
during and previous to the menstrual intervals, has 
permanently cured many obstinate cases in my hands. 
I generally advise these patients to take one or two 
uterine tonic tablets four times a day, and each night 
before retiring, use the prolonged vaginal douch, and 
insert the extra-uterine application, which is allowed 
to remain until the next night. This treatment is con- 
tinued each day, for a few weeks or months, until all 
distress at the period has disappeared. 

In connection with this treatment, I have many 
patients visit the office twice a week, where I keep the 
cervical canal dilated, with the electric current, and 
treatment described in Ammenorrhoea. If the cervical 
canal continues to remain open, and we are sure there 
is no obstruction, the continuous current is applied 
only to the cervical canal, with the negative pole: the 
positive pole to the abdomen. This means of keeping 
the uterine canal open with electricity, and relieving 
the congestion by the other medications, will establish 
a permanent cure in fully ninety per cent of all cases 
of obstructive congestive and neuralgic dysmenorrhoea. 
In the membranous variety, which, fortunately, is not 
very common, we have a different condition to deal 
with, and electricity alone will usually destroy and 
prevent the formation of this membrane, if used as 
described under the caption of "electric currettment," 
to which you are referred. 

MENORRHAGIA AND METORRHAGIA. 

Menorrhagia, or excessive flow at the menstrual 
period, and metorrhagia, a flow during the interval of 
the period, are not diseases within themselves, but are 
symptoms of disease, bearing different classifications; 
thus we find these conditions existing in fibroid tumors, 
cancers, retention of the secundines after miscarriages, 
endometritis, etc. Whatever may cause these profuse 



302 GYNAECOLOGY 

hemorrhages requires our attention to check the flow, 
and remove the cause, if possible ; this will be thor- 
oughly discussed in treating the diseases in which this 
condition occurs. 

METRITIS AND ENDOMETRITIS. 

Endometritis is an inflammation of the mucous 
membrane lining the womb, while Metritis is an in- 
flammation involving the entire organ. The latter is 
generally the extension of the former. Their symptoms 
are so near alike that they can well be discussed 




CONGESTED CERVIX OF METRITIS. 

Cause. — Catching cold or imprudence at the men- 
strual period, the extension of simple or specific in- 
flammation of the vagina or other pelvic organs, in- 
judicious or unclean intra-uterine medicated injections. 
The unskillful use of instruments and appliances, such 
as sounds, curettes and stem pessaries in the hands of 
inexperienced physicians, bear the responsibility in 
many cases. Improper and neglected attention during 
child-birth, miscarriage, and the lying-in period, deform- 
ities of the womb and canal, tumors, etc. 



GYNAECOLOGY 



303 




ENDOMETRITIS— UTERINE CATARRH. 



304 GYNAECOLOGY 

In making a speculum examination of the external 
os, the first thing which attracts our attention is the 
enormous amount of glairy, tenacious, semi-fluid, ropy 
substance, oozing from the external os, (see accom- 
panying illustration). This is the condition referred 
to, by the older writers, as "Uterine Catarrh," and is 
the pathognomonic symptom of these diseases. There 
is, of course, profuse leucorrhoea; as the result of this 
discharge, derangements of menstruation, especially 
menorrhagia and dysmenorrhoea are often present, due 
at times to the obstruction of the canal by the tenacious 
substance. 

Sterility is also traced to the same cause. There 
are, also, bearing down pains, and sensations of weight 
and dragging in the back; sensitiveness over the womb. 
Nausea and vomiting may be present, indicating a 
sympathetic irritation of the digestive organs. 

Treatment — In this condition we have a diseased 
membrane to deal with, and our only means of estab- 
lishing a permanent cure is to remove this old, diseased 
tissue, in much the same way as we build new skin on 
the face with the ecorchement treatment. This is done 
by a combination of medical agents with electricity. 
By this, apparently, simple method, "currette" the 
uterus with a copper electrode, attached to the positive 
pole, as previously described. After this treatment, 
inject about eight minims of the extra-uterine applica- 
tion. This treatment should be repeated about every 
four or five days, for a month or longer, or until the 
discharge has ceased, and the organ resumes its normal 
condition. 'During this time the patient is advised to 
use the vaginal douch before retiring, followed by an 
extra-uterine application, and the uterine tonic tablets, 
or whatever other treatment is required ; this is* a re- 
markably successful treatment. We have ''curretted'* 
the uterus, and stimulated the tissues by electricity, and 
reinforced this treatment by depleting effete matter, 
and reorganizing the circulatory nervous system of the 
female generative tract. 



GYNAECOLOGY 305 

CORPOREAL ENDOMETRITIS, EROSIONS, ETC. 

In making all speculum examinations, the first thing 
the physician observes is the condition of the os uterus, 
as this is the "tell tale" of many diseases. These objec- 
tive symptoms often allow us to determine, at a glance, 
the exact condition of local or more remote disease; it 
is, therefore, one of the methods of diagnosing disease 
witho.ut asking any questions. - 

Simple erosions are usually the result of excoriating 
discharges, arid usually heal after we cure their pri- 
mary cause. They may be produced by injury from 
syringe nozzle and other instruments, or the extension 
of inflammation from the vagina, too hot or corrosive 
injections, etc. ; on the other hand, the neck and os of 
the uterus may picture out morbid conditions, cancer, 



EXPLANATION OF ACCOMPANYING ILLUSTRATION, PAGE 3 06. 

Top Cuts — 1. Simple Granulations. 2. Follicular Cysts. 

Middle Cuts — 1. Polypus. 2. Follicular Cysts and Structures of Cer- 
vical Canal. 3. Cysts with Fungus Ulceration. - 

Bottom Cuts — 1. Excrescences of the Cervex. 2. Corporeal Endom- 
etritis. 



(see tumors), or benign tumors, polypus, fibroid, etc., 
many of which are illustrated in this chapter. Where 
an erosion exists uncomplicated it may be readily healed 
by a few applications of the Fitzhugh electrode, (illus- 
trated here), attached to the positive pole, using thirty 
to forty milliamperes, after which they are painted with 
the intra-uterine application ; generally three or four 
treatments will establish the desired results. Follicu- 
lar erosion should be opened with the knife, and after- 
wards treated in the same manner. 

Corporeal endometritis is a diseased condition in- 
volving only the membranes of the cervical canal. 
This is treated with the intra-uterine copper electrode, 
attached to the positive pole, and the same technique 
carried out as when the cavity is treated, previously 
described. 



306 



GYNAECOLOGY 



[•■■ 




GYNAECOLOGY 307 

LACERATION OF THE CERVIX. 

The formation of the cicatricial tissue at the cervix, 
as the result of laceration during child-birth, was form- 
erly removed only by surgical means. The cataphoric 
use of thiosinamine promises a means of revolution- 
izing this practice, as these cicatrices may be dissolved 
and removed by this more agreeable procedure. The 
technique of which is as follows: 

iDr. Nieswanger, to whom is credited this valuable 
procedure, has designed special electrodes for this and 
similar cataphoric operations, which consist of a brass 
stem, with a platinum terminal, isolated its entire length 
with hard rubber, and the platinum tip surrounded by 
a perforated hard rubber ball, which can be removed 
for the purpose of covering the tip with medicated cot- 
ton. The medication used is the same as given in 
treating scar tissue, on another page. With the abdom- 
inal pad in position, attached to the negative pole, and 
the cataphoric electrode connected to the positive pole, 
previously saturated in the thiosinamine solution, is 
placed in contact with the cicatricial tissue on the cer- 
vix, and fifteen to twenty milliamperes of the continu- 
ous current turned on through the rheostat, and the 
treatment continued about ten minutes. It is often 
surprising to note the action this remedy seems to 
have in softening this tissue; it has a tendency, how- 
ever, to abrade the healthy mucous membrane, if the 
current is too strong, and these treatments should be 
continued at least once a week, to insure success. 

VAGINITIS AND URETHRITIS. 

Vaginitis and urethritis are so closely related that 
they may be discussed together. They consist of a 
simple or specific inflammation of the mucous mem- 
branes of the vagina or urethra. These diseases may 
be caused by the use of too hot, medicated or caustic 
injections, misfitted pessaries, and other mechanical 
appliances. Gonorrhoea infection is, however, respons- 
ible in the greatest number of cases. 



308 GYNAECOLOGY 

The patient will complain of pain, heat and swell- 
ing in the vagina, and upon examining the parts, it will 
be observed the mucous membrane of the vagina is 
highly inflamed, with numerous granulations upon the 
surface, (see accompanying illustration B above, A be- 
low). By making pressure upon the urethra, (see A 
above), a few drops of greenish pus will ooze from the 
cavity. The inflammation may extend upwards, and 
the uterine canal will be filled with a muco-purulent 
discharge, (see B below), which will later develop into 
chronic endometritis. If there is any one condition in 
which the extra-uterine application will prove its spe- 
cific value, it is in the treatment of Vaginitis. Within 
ten minutes after the treatment is applied the distress 
will subside by its palliative effect, and by continuing 
this treatment, a thorough and permanent cure will 
rapidly follow. Each treatment should be preceded by 
the vaginal douch, and in severe cases, the application 
should be applied four or five times a day, in a cocoa- 
butter base ; if the cervical canal and urethra are 
affected, they should also be treated with bougies, con- 
taining protargol, during the acute stages. 

If the healing process is retarded, from any cause, 
or the case has developed into a sub-acute or chronic 
state, involving the deeper folds of epithelium, elec- 
tricity is one of the most potent measures. The germ- 
icide and astringent effects of copper, when cataphoric- 
ally deposited by the copper electrode, from the posi- 
tive pole, and continuous current, is so powerful it 
will rapidly destroy gonorrhoea, or other existing germs; 
usually, three or four treatments will be sufficient to 
establish a complete cure. The technique of the oper- 
ation is as follows: A local anaesthetic should be in- 
jected into the urethral canal, as the patient will not 
be able to withstand the pain, in many cases. The 
copper electrode is now introduced, attached to the pos- 
itive pole, and from five to ten milliamperes of current 
used, for about five minutes, repeating this operation 
every four or five days, until a cure is established. 



GYNAECOLOGY 



309 




ilO 



GYNAECOLOGY 



INFLAMMATION AND CYSTS OF THE 
BARTHOLINIAN GLANDS. 

As a consequence of vaginitis or injury, inflamma- 
tion and suppuration of the glands of Bartholin is of 
very common occurrence. These glands lie beneath 
the labia minora and majora, and are about one-half 
inch long; sometimes develop, especially in prostitutes, 
as lars:e as an almond. Thev contain a duct of suffi- 




L.I3EASE OF BARTHOLINIAN GLANDS. 

cient size to admit a bristle, which is about one-half 
inch long. The accompanying illustration, (Fig. 1). 
shows the edand in the acute stage of inflammation; 
the upper right hand cut shows a dissection of the 
parts, exposing the glands, and right lower figure, the 
formation of a cyst, as the result of the closure of -the 
duct. 



GYNAECOLOGY 311 

The polliations in women are due to. this gland. 

A simple cyst (Fig. 3), may develop, varying in size 
from a nut to a goose egg, and contain a colorless fluid, 
sometimes mixed with blood. The contents have been 
evacuated, and after aspiration, treated like a hydrocele, 
by injecting thuja, (see hydrocele), or ten or twelve 
minims of a chloride of zinc solution. Another later 
procedure, is to evacuate the contents, and fill the cyst 
with paraffin, which outlines the cavity, which is thor- 
oughly dissected away, like a fatty tumor, using cocaine 
to obtund the pain. 

Inflammation and suppuration of this gland is, how- 
ever, of the most frequent occurrence following gonor- 
rhoea, (Fig. 1) ; by pressing on the duct, a greenish or 
milky pus is expelled. These may be freely opened, 
and treated as a common abscess, and, if the inflamma- 
tory action re-occurs, complete extirpation of the gland 
is necessary. 

URETHRAL CARUNCLE. 

Is an inflammation of the urethral glands, at the 
orifice of the urethra, generally caused by gonorrhoea, 
and other irritating discharges. This is one of the 
most painful, apparently little, affections of the female 
organs. The papillae around the mouth of the canal 
are deep red, and will often not allow the gentlest man- 
ipulation. These irritating ulcers may often be exter- 
minated by the use of nitric acid, or nitrate of silver, 
if only superficial, but the best and most rapid means 
is to treat the growth with an electric needle, from 
the negative pole, in the same manner that warts and 
moles are destroyed. The parts should be previously 
anaesthetized with cocaine; carbon dioxide snow is also 
a very rapid and efficient means of destroying these 
growths. 

IMPOTENCY AND STERILITY. 

While text books for the treatment of diseases of 
women are prolific in discussing the pathological con- 
ditions of the female sexual system, very little is said 



312 GYNAECOLOGY" 

regarding impotency or sexual frigidity, and sterility ; 
yet these two conditions, more than any other, are sub- 
jects which greatly concern the marital happiness of 
man and wife. If we were to trace the court records, 
we would find stringent laws regarding impotency in 
the male that incapacitate manhood ; yet the unwritten 
law regarding sexual frigidity, or apathy in the female, 
remains silent with the physician, who is constantly 
consulted regarding this subject. It is, therefore, his 
duty to look the subject square in the face, and insti- 
tute such means as will cultivate this "active function 
of love," which is so essential to conjugal peace and 
happiness. I am satisfied that the physician can dim- 
inish the frequency of divorce, domestic infelicity and 
social evils, by correcting many physical defects and 
pathological conditions of the female sexual system. 
Our Creator has designed the functions of these organs 
for the harmonious procreation of the species, and any 
apathy which may exist by either sex, cannot be cor- 
rected by law-makers or statesmen, as these unwritten 
laws are only revealed to the physician, whose duty it 
becomes to advise and treat these patients. Every phy- 
sician is familiar with, the fact that congenial sexual 
relations are conducive to happy unions, and any devia- 
tion from this law is usually followed by domestic in- 
felicity. What is true of sexual apathy is likewise the 
rule with sterility. It is the heart's desire of nearly 
every man and woman to procreate, and be blessed 
with sons and daughters, to smooth the rough roads at 
the decline of life, and there is nothing quite so disgust- 
ing to a well-bred physician as to listen to a woman 
boast of the number of abortions she has had per- 
formed, and later meet her on the street, leading a 
poodle dog, which she calls "baby" ; really the string 
which unites the two links together, species which is 
often difficult to differentiate, from a moral and mental 
viewpoint, yet some "pin-headed" philosopher has the 
courage to call this a typical American family. 



GYNAECOLOGY 



313 



There are two degrees of sexual frigidity in women. 
The first is where there is absolutely no desire, no feel- 
ings for or during the sexual embrace, and the second 
is where this function is partially developed but with- 
out gratification, and the question arises: what can be 
done to awaken these organs to life and activity? There 
is only one remedy, which, apparently, has a specific 
aphrodisiac effect upon the female sexual system, and 
that is galega ; the evolution of this drug is somewhat 
interesting. Galega grows in its natural state, in large 
quantities, in Switzerland, and is also cultivated to a 




LINE OF INCISION AND SUTURES IN POSITION. 



great extent, and given cows, for the purpose of in- 
creasing their supply of milk. Its stimulating effect 
upon the mammary glands induced many women to use 
the remedy for the purpose of developing the bust, and 
rounding out the form ; it was discovered that the 
women who used the drug for this purpose found their 
sexual appetite was also greatly increased. It is this 
evolutionary proceeding which has introduced galega 
as one of our foremost remedies in the treatment of 
sexual apathy, in both male and female, and by com- 
bining this drug with other remedies, bearing a thera- 
peutic action upon nerve centers, as is given in the 
"pill that will" in the succeeding chapter, much can be 



314 GYNAECOLOGY 

done by internal medication to develop and awaken 
this dormant function. 

The surgical treatment consists of denuding the 
clitoris. This operation is analogous to circumcision 
in the male. The technique of the operation is simple ; 
the hood is pinched up with thumb and forefinger, and 
an injection of cocaine is given to obtund the pain; 
after the anaesthesia is completed, the hood is lifted 
from the clitoris, and a V-shaped incision is made from 
the apex downward, (see accompanying illustration), 
the denuded edges of the integument, and mucous 
membrane are united by four sutures, two at the apex 
and two at the base, (black silk was used in the accom- 
panying illustration, which may be confused with the 
line of incision), the wound is dressed in the usual way, 
and the sutures removed as soon as healing has taken 
place. This medical and surgical procedure has been 
the means of restoring this function in a great many 
cases in my hands, and you will find your efforts 
greatly appreciated by both husband and wife. 



STERILITY. 

Although sterility is frequently found in women with 
sexual apathy, these conditions are in no way related, 
as there are several causes why women cannot conceive 
and bear children. The principal of these is stenosis 
of the uterine canal, due to endometritis, where the 
uterine canal is obstructed with the thick tenacious 
secretions, preventing the entrance of the spermatozoa, 
as is illustrated on a preceding page. The history of 
many of these cases are the results of criminal abor- 
tions ; on the other hand, where a woman has never 
conceived, the uterine canal will often be found in a 
contracted state, as in the infantile uterus. These two 
conditions are conservatively estimated to be the cause 
in ninety percent of all cases, and by establishing- a 
healthy condition of the membranes of the uterus in the 



GYNAECOLOGY 



315 



former, and using either mechanical, or other dilatory 
means, in the latter, a great number of barren women 
may be made fertile. The method of maintaining dila- 
tion of the uterine canal by electricity has been previ- 
ously described. Many physicians prefer, however, me- 
chanical dilators, of which Outerbridge's stems offer the 
best means. These instruments are only used where 
the uterine membranes are in a healthy condition, for 
the purpose of keeping the canal continuously dilated, 




OUTERBRIDGES. STEM, DILATORS. 



and are of equal service in many cases of dysmenor- 
rhea, due to a constricted canal. Of course if any form 
of uterine catarrh exists, occluding the canal, they will 
not accomplish their purpose in sterility, and the dis- 
eased condition should be treated and cured first. 

Dr. J. Marion Sims was the first to introduce arti- 
ficial impregnation by injecting semen with a intra- 
uterine syringe ; although this method has never be- 
come popular in medical literature, it is more frequently 
practiced than is generally supposed, and will be found 
successful in a great many cases. 



316 GENITO-URINARY 



Genito=Urinary and Venereal 
Diseases. 



The diseases resulting from the "great social evil" 
have always contributed liberally to the physician's 
yearly income, as it may be conservatively stated that 
one-tenth of the physician's income, comes from this 
source; therefore, placing the average physician's in- 
come at $1,000.00 per year, there would be paid $14,- 
500,000 for medical fees in America, for the treatment 
of Genito-urinary and venereal diseases. This is such 
a profitable branch of medicine that the advertising 
physicians have nearly abandoned other diseases, stat- 
ing that they can receive larger fees, with less labor, 
than are obtained in any other specialty. It is this rea- 
son that makes this specialty so conducive to "quack- 
ery." The medical and minor surgical therapeutic pro- 
cedures have been greatly improved- in Genito-Urinary 
and venereal diseases, within the last few years. We 
will, therefore, outline many of the modern methods of 
treatment used in these special diseases. 

URETHRITIS. 

The most prevalent of venereal diseases has been 
described, from time to time, under the synonymous 
terms Menorrhagia, gonorrhoea, clap and urethritis. 
This disease, for a very long period, was a fruitful 
theme of debate, to identify this condition from syph- 
ilis. The history of this disease will date back to the 
origin of the first unclean woman, and that means the 
origin of the species ; therefore, Rudyard Kipling- need 
offer no apology for writing "the female of the species 



VENEREAL 317 

is more deadly than the male." Moses, in his wisdom, 
was the first to recognize and institute prophylactic 
measures to prevent this, and other venereal diseases; 
and in his code of moral laws the males were not only 
required to be circumcised, as it was thought the pre- 
puce was responsible for spreading disease, but the 
females were required to be separated from their hus- 
bands during the menstrual and other periods. These 
are the first prophylactic measures which history has 
given us. The vagina offers a most prolific field for 
the generation of germs, containing pathogenic prop- 
erties ; its exclusion from light, and the decomposition 
of the secretions from her own generative organs ; to- 
gether with the physiologic secretions from the male, 
the semen, and the irritation during coetus^ makes it a 
particularly favorable seat for decomposition, and the 
development of irritating toxins. 

The treatment of gonorrhoea consists of both inter- 
nal and local measures. The internal medication may 
cover a large number of remedies, but the true specifics 
are few in nifmber. The principal effects desired is to 
relieve the pain during the acute stages, and render 
the urine alkaline. The following, in tablet form, will 
be found very serviceable : 

I£ Ext. Kava-Kava . . . . •. . . 1 gr. 

Potass. Bicarbonate 2 gr. 

Oil Sandal 1 gr. 

Oil Cubeb . . V 2 gr. 

Balsam Copaiba . . . . . . . V 2 gr. 

Iron Sulphate . J A gr. 

Salol 1 gr. 

Pepsin Pure V 2 gr. 

Two tablets three or four times daily. 

The local treatment is of the greatest importance, 
and I always prefer these medications in the form of 
urethral bougies, as it is more accurate, convenient and 
thorough than other forms of local medication. These 
treatments are supplied in the form of long, narrow 
pencils, which are used with an applicator, (as is illus- 



318 GENITOURINARY 

trated here), or each bougie is wrapped in paraffin 
paper coil, or tube, which answers the purpose of an 
applicator, and also protects the bougies from melting 
when not in use. This is the best means of reaching 
all areas of the urethral tract; and has the advantage in 
prolonging the medication to any diseased area. 

The following formula in bougie form is as near a 
specific for urethritis as can be obtained by medicine : 

I£ Protargol T 4 gr. 

Hexamethylenamine M g r - 

Quinine and Urea hydrochloride . . .1-6 gr. 
Sig. — Use a bougie three or four times a day, and 
before retiring. Always instruct your patient to urin- 
ate before each application, as this clears the canal of 
toxic secretions. 




A 

URETHRAL, APPLICATOR AND BOUGIE. 

In resuming the above formula, we have the com- 
bined astringent and antiseptic effects of Protargol, 
which has long been recognized as superior to other 
astringents, or germicides, in the treatment of this dis- 
ease ; this is reinforced with Hexamethylenamine, whose 
relation to formaldehyde makes it a most favorable 
treatment for the destruction of micro-organisms. 
Quinine and urea hydrochloride is not only a mild as- 
tringent, but also an anodyne and prolonged anaesthetic. 
The addition % of this remedy is indispensable in treat- 
ing this disease, as its obtunding properties immedi- 
ately stop all pain and irritation, while the other med- 
ications are effecting their permanent results. In fact 
many patients will state they would not know they 
were diseased if it were not for the discharge. 

STRICTURE. 

Stricture is a narrowing of the urethral canal from 
any cause, and may be spasmodic, congestive, inflam- 
matorv or fibrous. This is one of the most frequent 



VENEREAL 319 

complications of gonorrhoea, and although the different 
forms cannot always be differentiated clinically, it be- 
comes the physician's duty to institute a means whereby 
the canal will maintain its normal caliber. For thi? 
purpose, there have been many different treatment? 
used, from time to time. Space will not allow a dis- 
cussion of all these methods: we will, therefore, con- 
fine our treatment to the more simple and practical 
measures. 

A large percentage of strictures following gonor- 
rhoea are the results of forming fibrous tissue, due to 
the inflammatory process narrowing the canal; thus. the 
treatment is directed to dilate or stretch the canal to 
its normal caliber, or absorb the fibrous tissue by elec- 
tricity or medicated bougies. The gravity of stricture 
will depend upon its distance from the meatus; the 
nearer this orifice the more easily cured, and the farther 




FIBROUS STRICTURE. 

the distance the more difficult to master. Forced dila- 
tion does not offer us a successful treatment, except in 
the most superficial constrictions. When the stricture 
is deep seated, they may be made to admit a large 
sized sound, and we congratulate ourselves that we 
have relieved the constriction only to be disappointed 
by the patient returning in a few days with no appar- 
ent improvement. It has been demonstrated, however, 
that thiosinamine applied in bougie's, after dilation, 
would produce permanent results. The technique of 
the operation is as follows: locate the seat of the con- 
striction, and dilate the stricture with graduated sounds 



620 GENITOURINARY 

as far as possible, and, after withdrawing the sound, 
insert a bougie composed of the following: 

I£ Thiosinamine . . . .' . . . y 2 gr. 

Resorcin ^gr. 

S. E. Thuja y± gr. 

-A few of these dilatations and medications will usu- 
ally overcome the most obstinate cases of urethral con- 
striction due to fibrous tissue. Thiosinamine may also 
be used by cataphoric application as follows: the cata- 
phoric urethral electrode, (shown on page 275), is sat- 
urated with the thiosinamine solution, as for treating 
scar tissue. This is inserted to the constricted area, on 
the positive pole. The negative pole placed on the ab- 
domen, and five milliamperes of current used for five 
minutes. A very few of these treatments will be fol- 
lowed by the most excellent results. 

VARICOCELE. 

The frequency in which varicocele occurs, in the 
adult male, has offered a field for an independent spe- 
cialty, and nearly every city contains a "Varicocele 
Specialist," who, as a rule, charges the uniform price 
of $100.00 for treating this disease. The injurious 
effects depicted by these specialists, are greatly exag- 
gerated, however, with a view of depleting the purses, 
by frightening the victims with the statement that this 
disease will result in impotency, while the truth remains 
that this disease is not a serious condition, and pro- 
duces comparatively little discomfort. 

Surgeons differ greatly in estimating the frequency 
in which this disease occurs. Dr. Henry, police sur- 
geon of New York, found 41 cases in 2,000 robust and 
healthy men, examined for police service. Ludston 
gives an estimate of 5 per cent, in men examined for 
military service, which would give a better percentage 
for average healthy men. At any rate, varicose veins 
are more frequently found in the plexis of veins sur- 
rounding the spermatic cord than in any other part of 



VENEREAL 



321 



the body, and often require treatment to cure this con- 
dition, even if the disease is not dangerous. It relieves 
the annoyance, portrayed by bold advertising, upon the 
minds of many neurotic patients, and prevents them 
from falling into the clutches of the quacks, who point 
at this condition as a consequence of noctural emis- 
sions, masturbation, and resulting in "physical decay" 
or impotency. 













m 






THE OPEN LIGATION OPERATION. 



There have been many operations devised for the 
relief of this condition ; the two which have been the 
most universally successful are the open ligation, and 
the subcutaneous ligation. I prefer the former, as you 
are not required to work in the dark. The open liga- 



322 GENITO-URINARY 

tion method is a very simple operation, and you have 
the "minute anatomy constantly under your observa- 
tion,, and avoid any possibility of including in your lig- 
ature tissue which is not required, and often leaves 
unfavorable results by not completely strangulating the 
veins. 



TECHNIQUE OF OPERATION. 

The field of operation is made surgically clean by 
shaving, and bathing the parts with a bichloride solu- 
tion, and a local anaesthetic injected into the parts to 
obtund the pain; a small incision is made, high up as 
possible, the varicose veins located, and tied with 
chromicized catgut, being careful not to include the 
vas deferens or other tissues; the wound is now closed, 
under antiseptic precautions, and sealed with collodion. 
In the subcutaneous operations the same results are at- 
tempted, but it is almost impossible to isolate the veins 
and ligate them without including other tissue, even in 
the most skilled hands. The technique of the opera- 
tion is as follows : 

After observing surgical cleanliness, and the us-e of 
a local anaesthetic, if necessary, (this is seldom re- 
quired, however, in this operation), the Whitehead or 
Riverdine needle, threaded with an antiseptic ligature, 
is made to transfix the scrotum at a distance of the 
junction of the upper middle third of the distance from 
the inguinal ring to the testis; after the needle has 
passed through the scrotum the vas deferens should be 
located internally, and separated from the veins. The 
needle is now transversed to the point of first entrv, 
and if the operation is successful, the two ends of the 
ligature tied, which includes the mass of veins produc- 
ing strangulation. The point of puncture should be 
-sealed with collodion. 



VENEREAL 323 

HYDROCELE. 

Hydrocele consists of an accumulation of serous 
fluid, in the tunica vaginalis testis caused by continuous 
irritation. This is found in ten percent, of the male 
population in Brazil and other tropical climates where 
the scrotum being relaxed and pendulous is more liable 
to injury. Wearing trousers tight in the crotch has 
also been given as the cause of injury. While there 
are several methods advocated to permanently cure this 




THE HYDROCELE OPERATION. 



condition the injection, treatment, in its different forms, 
is in the greatest favor. There have been many rem- 
edies advocated for this purpose, among which may be 
mentioned all the astringents, sulphate of zinc, alum 
and the vegetable astringents depending upon tannin ; 
.tincture of iodine and carbolic acid are also eeneral 



324 GENITO-URINARY 

favorites. The former is the most universally used,, 
but the latter has been demonstrated to be of the great- 
est value, and owing to its anaesthetic properties ren- 
ders the operation nearly painless. I prefer the tinc- 
ture of thuja, however, to any of the injection remedies. 
Many newly formed hydroceles are permanentlv 
cured by only withdrawing the fluid, and in reviewing 
this history, I only use this means for the first opera- 
tion, but if the sac is refilled, or in old chronic cases, 
the injection treatment should be used. The technique 
of the operation is as follows : 

The tumor is held in position with the left hand, 
while the right hand forces a trocar well into the sac, 
see illustration, avoiding the testicle; the trocar knife is 
now removed, and the fluid withdrawn, with the metal 
cone of the trocar still inserted in the sac. A long, 
blunt pointed needle is inserted through the metal cone, 
through which is injected the following solution into 
the sac : 

^ Thuja (Lloyd's specific) . . . . . V 2 oz. 
Glycerine 1 and y 2 oz. 

This should be manipulated rather vigorously until 
the entire surface has been thoroughly covered, and the 
solution is allowed to escape, and the site of puncture 
sealed with collodion. This is, as a rule, a very suc- 
cessful operation, and I prefer thuja to carbolic acid or 
iodine, and other astringents and caustic remedies, as 
we obtain an equal degree if success with less heroic 
measures. The patient should wear a suspensory band- 
age for a few days, and in old and feeble patients it is 
best that they should remain in bed for a few days 
until the reaction thoroughly subsides. 

SPERMATORRHEA. 

Spermatorrhoea, nocturnal emissions and impotency- 
are the three conditions of the male sexual system 
which have ofrered the advertising physicians of the 
past the most profitable field for their operations, to 
commercialize medicine, by both local advertising and 



VENEREAL 



325 



in the mail order business; owing to their bold adver- 
tising in the yellow press, the regular physicians have, 
apparently, neglected these conditions, fearing, per- 
haps, if they would give them due consideration, they 
would be associated with the bold faced quack, but in- 
asmuch as many state and national laws have stopped 
their operations, the general practitioner may now con- 
sider this a legitimate field. Through the cleverly 
worded advertisements of the charlatans, the laity have 
been taught that nocturnal emissions and spermator- 
rhoea are of the same condition ; although spermator- 
rhoea has been defined as an involuntary loss of semen, 




THE SPERMATORRHOEA RING. 

independent of intercourse, it does not necessarily in- 
volve nocturnal emissions. True spermatorrhoea is 
caused from a weakness of the seminal ducts, while 
nocturnal emissions are a physiological phenomenon, 
characteristic of the vigor of youth. By painting, in 
these young minds, the picture of lost vitality, ''weak 
manhood" and "general debility," which will terminate 
in placing the victims behind prison bars, and in mad 
houses, has constituted the blackest sheet in medical 
advertising; on the other hand the secretions which es- 
cape while straining at stool, and during sexual excite- 



326 GENITOURINARY 

ment from the prostate and Cowper's gland have also 
been used in their argument to frighten their patients. 
What is there in the practice of medicine more con- 
demnable than to attempt to create disease for the pur- 
pose of curing it for personal gain? 

The above outlines the conditions described by some 
writers as pseudo spermatorrhoea. The fact remains 
that true spermatorrhoea is not of very frequent occur- 
rence, but when it does appear, is the result of sexual 
excesses, masturbation or perhaps excessive nocturnal 
emissions, or a combination of all three causes, result- 
ing in a weakness of the organs, whereby diurnal or 
nocturnal emissions take place without sensation or 
power. 

The treatment of spermatorrhoea may include moral, 
psychic, medical and mechanical measures. The pa- 
tient should be advised that nocturnal emissions, in the 
young and vigorous, is not of a serious consequence, as 
is portrayed by the quack, and unless this condition is 
at too frequent intervals will not terminate in serious 
results. 

'Masturbation is the most frequent cause, however, 
and although the patient will usually deny this prac- 
tice, he should be emphatically advised to abandon the 
habit. Nocturnal emissions may often be relieved by 
sedatives, but the most positive way of mastering this 
condition is with the so-called "Spermatorrhoea ring,'' 
illustrated here ; although this instrument is a product 
of an advertising physician, who in the past has reaped 
a fortune from its sale, it is now extensively used by 
many physicians. The ring is placed around the penis, 
while in a flaccid state, at its base on retiring, and if an 
erection takes place during the night it will expand and 
prick the organ, thus awakening the patient, who 
should be advised to urinate at this period before going- 
asleep again ; with the use of this instrument, and 
moral advice, we have at our command the only radical 
cure, as far as relieving the cause is concerned, but 
where these cases present themselves at a late hour, 
we have a different condition to deal with — Impotency. 



VENEREAL 327 

IMPOTENCY. 

Impotency has been described, by most writers, as 
existing in two forms viz : pseudo-impotency and true 
impotency. In the former there seems to exist, in cer- 
tain individuals, a lack of confidence in themselves, or 
they may be impotent with blondes, and not with 
brunettes, and vice-versa ; in others, the erection may 
be weak, with premature ejaculation. These are often 
due to conditions of the mind. He remembers the ad- 
vertising- literature of the quack, and comes to the con- 
clusion that he is physically weak. It is this condition 
that the family physician has neglected and treated 
lightly, and the charlatan has magnified the evil conse- 
quences for large professional fees. The only treat- 
ment required for many of these cases is suggestive 
therapeutics, and relieving their minds of any impend- 
ing danger. Do not laugh at his imaginary troubles, 
and actually drive him into the hands of the quack with 
your ridicule, but treat him with all the seriousness of 
a more grave condition. There are many ways of 
stimulating the sexual organs, whereby profound and 
prolonged erections may be maintained; the passing of 
a cold sound twice a week, or an application of the elec- 
tric current, may produce the desired results. Prema- 
ture ejaculations may be due to an excessively sensitive 
gland penis, as a consequence of a phymosed prepuce 
and circumcision will effect a cure, while much can be 
done in false or nervous impotency by establishing a 
feeling of self-confidence in the patient. True impo- 
tency due to an exhausted condition of the sexual ap- 
paratus and nervous system from excesses, will require 
more heroic measures. 

Many remedies under the classification of aphrodis- 
iacs have appeared from time to time, and although ex- 
cellent results have been obtained from many of these, 
there are few specifics; the "following, however, in tab- 
let form, offers the best combination of medicinal agents 
I believe in present use. It has reached at least a suf- 
ficient degree of perfection to be referred to by many 



328 GENITOURINARY 

physicians as the "pill that will." The formula is as 
follows : 

^ S. Ext. Galega 3 gr. 

Chromium sulphate ....... 2 gr. 

Zinc phosphide 1/10 gr. 

Ext. Xux Vomica V\ gr. 

Cannabin • . . 1/10 gr. 

Cantharides 1/12 gr. 

Avenine 1/200 gr. 

Sig. — A pill six times a day. 

In resuming the therapeutic value of the above form- 
ula I believe Galega to be the most specific remedy we 
have for the treatment of impotency for either sex. It 
is a glandular stimulant and, apparently, has a select 
action upon the sexual organs of both sexes (see page 
315.) 

In conjunction with the above tablet I frequently 
prescribe the fluid extract of Galega in one-half dram 
doses, to stimulate the secreting glands of the sexual 
system, and I have often been surprised at the new life 
it establishes in dormant or worn-out sexual systems, 
in both sexes. This remedy is reinforced with Chro- 
mium sulphate, Phosphide of zinc and nux vomica; 
each bearing their tonic and stimulating influence to 
the nervous system. Cantharides may be called the 
true sexual excitant in small doses, which is likewise 
reinforced with the alkaloids, Avenine and Cannabin. 

This tablet has a wide range of usefulness, and al- 
though it has achieved the name "the pill that will." 
through its success in treating impotency. it is of equal 
service in many other conditions, where a nerve tonic 
is required. It is one of the best medications for the 
tremor of alcoholism, and to build up the system after 
debauch, spinal and cerebral anemia, locomotor ataxia, 
and many other nervous diseases, are also successfully 
treated with this medication. 

Vibratory massage with the ball vibratode from the 
tenth dorsal to the coccyx, using the medium speed 
and long stroke, occupying from six to eight seconds, at 



VENEREAL 



329 



each center, is of much more value in functional im- 
potency. Electricity to the same area, with the brush 
applicator to the penis, has been successfully used in 
many cases. There has been rather elaborate cupping 
apparatus devised for the purpose of exciting the sex- 
ual system by increasing the blood supply, by the Bier 
method. A far better and more successful treatment, 
however, is to ligate the two superficial dorsal veins of 
the penis, (veins dorsalis penis superficialis) ; this is a 
very simple operation, and involves just sufficient tech- 
nique to be called a "surgical operation," and is there- 




LIGATING THE VEIN BY OPEN OPERATION, 

fore used to a good advantage in extracting large fees 
by the irregular physician. The technique of the oper- 
ation is simplicity itself. The parts are made surgic- 
ally clean and anaesthetized with cocaine; pick up the 
veins with the thumb and finger, and pass a small 
curved needle through the integument, and under the 
vein near the base of the penis. The needle is now 
transversed, entering at the exit, and passed above the 
vein to the point where it first entered, and ligated, and 
the two openings sealed with collodion. Both veins 
should be treated in this way. The object is to oblit- 
erate the veins, and cause congestion of the organ, the 
reaction of which will produce the necessary erection. 



330 GENITO-URINARY 

Some prefer the open operation as is illustrated here, 
as you have your work constantly before you as in the 
varicocele operation. This operation, and the use of 
the ''pill that will," will restore this function, in a large 
majority of cases, and many physicians have the cour- 
age to charge a fee of $100 for this procedure, and the 
patients seem to believe they have received their 
money's worth, and thus their prayers are answered : 

"Blessed are they of human race, 
To whom the Lord has given grace 
To hope, to learn to wish and pray, 
When one little stitch will pave the way.'' 

HYPERTROPHY OF THE PROSTATE. 

From the age of forty to the decline of life enlarge- 
ment of the prostate gland is of such frequent occur- 
rence that it is often looked upon as a natural conse- 
quence, rather than a disease, and if our Creator has 
selected any one organ of the male sexual system to 
equalize or correspond to the suffering endured by wo- 
men for the pro-creation of the race, he has concen- 
trated his efforts in this gland, which is often referred 
to as analogous to the uterus of the female. This over- 
growth of tissue is not only a constant menace during 
advanced years, but it often robs the patient of many 
years of his life, unless therapeutic measures are insti- 
tuted for its relief or cure. 

These patients will generally consult the physician 
under the erroneous idea that their kidneys or bladder 
is diseased. They will complain of difficulty in start- 
ing the urine ; although there is a frequent desire to 
urinate, especially at night. Will also state that the 
stream and force is diminished, even to dribbling, and 
the bladder is unrelieved by his efforts. These symp- 
toms, together with neuralgia pains in the penis and 
testicle, with a sensation of weight in pelvis, and a dis- 
charge of glairy mucous will reveal to you an enlarged 
prostate. To confirm the diagnosis, however, a digital 



VENEREAL 331 

examination is made through the rectum, and the pa- 
tient is requested to pass his urine in your presence to 
observe the force and volume of the stream. 

The treatment of enlarged prostate will naturally 
be divided into palliative measures, for the immediate 
comfort of the patient, and those directed to produce 
permanent results. Hyperacidity of the urine, and irri- 
tation at the neck of the bladder may be relieved by 
Triticum, Repens, Pichi, Oil of Sandalwood, Buchu 
and other similar treatments. Hexamethylenamine, 
which is also sold at fancy prices, under the coined 
name of "Cystegen," is one of the best remedies, espe- 
cially where there is decomposition of urine. With this 
remedy we receive all the benefits from formaldehyde 
in a convenient form to dispense. 

In advanced cases the residual urine should be with- 
drawn, and the bladder washed occasionally , to prevent 
decomposition. The passing of sounds will often afford 
temporary relief, by increasing the force and caliber of 
the stream. 

Of the internal remedies, which have been given 
with a view of producing permanent results, Ergot, 
Saw. Palmetto and Galega perhaps are in the greatest 
favor. These, administered in combination, in the fol- 
lowing formula, will produce better results than any 
medication to my knowledge : 

tf F. E. Ergot 1 oz. 

F. E. Saw Palmetto . . . . . . 1 oz. 

F. E. Galega 2 oz. 

Simple Elixor, q.s 6 oz. 

Sig. — A teaspoonful three or four times a day. 

Although Ergot and Saw Palmetto have long been 
looked upon as favorite remedies for enlarged prostate, 
reinforcing these drugs with Galega is of a decided ad- 
vantage, as this remedy has a remarkable influence in 
stimulating glandular tissue. 

The trend of modern therapeutics has a tendency, 
however, to favor local medication, m the. form of sup- 
positories, applied through the rectum to the prostatic 



332 GENITO-URINARY 

area ; and also the cataphoric application of drugs. A 
suppository which has rendered me much service is as 
follows : 

1$ Thiosinamine 4 gr. 

S. E. Saw Palmetto 4 gr. 

S. E. Galega ........ 1 gr. 

Cocoa-butter, q. s 24 gr. 

Apply through the rectum to the prostatic area be- 
fore retiring. 

The thiosinamine solution used to. remove scar tis- 
sue, as advocated by Dr. Nieswanger, is also one of 
the most successful means of treatment at our disposal. 
These methods used independently, or in combination, 
will give relief, and apparently cure a large number of 
these obstinate cases. 

In order that I may outline the method of using the 
combined treatment, I will cite the following case : 

Mr. H. — aged 64, merchant, from subjective symp- 
toms and digital examination, presented a typical case 
of prostatic hypertrophy, with most of the symptoms 
previously described, and was obliged to urinate several 
times during the night ; he was directed to take a tea- 
spoonful of the Galega compound," three times a day 
and a prostatic suppository was applied each night be- 
fore retiring. 

Every four days the patient visited the office for the 
cataphoric application of thiosinamine; the technique of 
its application was nearly the same as advocated by Dr. 
Nieswanger. An electrode, (shown in Fig. 1, page 
295), was used, by using an applicator of galvanized 
iron, instead of copper wire. This applicator was loosely 
wound with absorbent cotton for about two and one- 
half inches, and saturated with the same thiosinamine 
solution, as is used for removing scar tissue, on page 
247. The wire applicator is slipped into the hard rub- 
ber protective shield of the applicator. This was well 
lubricated, and passed to the prostatic area of the 
urethra, attached to the positive pole ; the negative pole 
applied to the abdomen with the pad electrode. The 



VENEREAL 333- 

continuous current was gradually turned on, until it 
reached ten milliamperes, and the current allowed to 
flow from eight to ten minutes. 

At the end of two weeks the patient would not be 
disturbed of his sleep, by the desire to urinate in the 
night, and in less than two months was discharged as 
cured. 



CHRONIC CYSTITIS. 

This form of inflammation of the bladder, frequently 
succeeds the acute disease and continues as a low in- 
flammatory catarrhal process ; taking on acute symp- 
toms at times and again lapsing into the sub-acute 
state. This is especially so when accompanied with 
enlarged prostate. The following formula has been of 
much service to me. 

^ Hexamethylenamine 2 gr. 

Ext. Corn Silk ........ 1 gr. 

Ext. Pichi . 1 gr. 

Ext. Buchu 1 gr. 

Ext. Hydrangea 1 gr. 

Atrophine Sulph. 1.600 gr. 



Dose : A tablet every three hours followed by a 
large glass of water. 

This simple eclectic prescription has also given me 
excelent results: 

5 Cannabis Indica. (Lloyds) . . . . 1 dr. 

Collinsonia 2 dr. 

Gelsemium ^ dr. 

Aqua, q. s. 4 oz. 

Sig. : Teaspoonful every hour for 12 hours then 
teaspoonful every four hours. 



334 HERNIA 



Hernia. 



The treatment of hernia, up to the sixteenth cen- 
tury, constitutes the darkest pages in medical history. 
These unfortunate sufferers were objects of scorn and 
ridicule, denied access to society, and shut out from 
positions of honor and rank, while the strangulated were 
all abandoned to themselves to die. In the latter part 
of the seventeenth century the spring truss was in- 
vented, and from that advent, the mechanical and sur- 
gical treatment of hernia has gradually progressed, until 
we have at our command several successful means of 
curing this condition. 

iHernia is another condition which has offered the 
physician an inviting field in which to specialize, owing 
to the frequency in which rupture is found. Several 
years ago. Bryant gathered the statistics, and recorded 
93,355 hernia cases, with a view of finding the relative 
percentage of the different forms of hernia; out of this 
number of cases there were 46,551 simple inguinal, to 
7,492 femoral, without distinction of sex; of 30,575 dou- 
ble hernia, there were 28,503 inguinal and 1.972 femoral. 
The sum of his figures were 75,054 simple and double 
inguinal to 10,425 simple and double femoral, being one 
femoral to 7.10 inguinal. Malgaigue also gives statis- 
tics regarding the frequency of hernia in relation to 
population, and he estimates the proportion of the 
whole population of France, that is ruptured, to be one 
out of every thirteen males, and one out of every fifty- 
two females, or taking both sexes together, one out of 
every 20.5 individuals. The accompanying illustration 
shows the different forms of hernia and their location : 
some of these are so rare, however, that they are con- 
sidered curiosities when presented. 



HERNIA 



335 



Judging from these statistics, we can readily see 
why the treatment of rupture makes a remunerative 
specialty. There have never been any cutting in fees 
with rupture specialists. The price for such treatment 
is usually $100.00 for single and $150.00 to $200.00 for 
double hernia. 




1. Epigastric Region. 2. Lumbar Region. 3. Umbilical Region. 4. 
Femoral Region. 5. Poupart's Ligament. 6. .Scarpa's Triangle. A. Epi- 
gastric Hernia. B. Hypochondriacal Hernia. G. Lumbral Hernia. D. 
Umbilical Hernia. E. Ventral Hernia. F. Inguinal Hernia. G. Direct 
Inguinal Hernia. H. Crural Hernia. I. Femoral Hernia. 



TREATMENT OF RUPTURE. 



The treatment of rupture is divided into palliation 
of rupture, or supportive measures, and those which 
have a tendency to permanently close the canal. The 
former will depend upon a suitable truss, while the lat- 
ter involves many different surgical procedures. We 
will only discuss, however, the three operations which 
are the most suitable and practical for the office spe- 
cialist. 



336 HERNIA 

THE TRUSS. 

It was the latter part of the seventeenth century 
that the first spring truss made its appearance, and 
although a very crude affair, compared with the mod- 
ern truss, it offered great relief and improvement to the 
only means previously used of carrying and supporting' 
their hernias in cloth bags. 

The modern apparatus employed for the retention of 
hernia have been brought to great perfection in the 
past few years, and when it is considered how great is 
the number of ruptured persons in the community, to- 
gether with the essential relief they receive from these 
appliances, they must be regarded as one of the most 
useful productions of modern surgical appliances. The 
ingenuity of American truss-makers has enabled them 
to produce apparatus far superior to those made in 
other parts of the world. The object to be obtained by 
the application of a truss is to close the opening throug'h 
which the protrusion has taken place, by means of ex- 
ternal pressure,, and thereby, after reduction has been 
effected, to prevent a second descent. A well-made in- 
strument should exert sufficient and uniform pressure to 
keep the hernia in place, without being easily displaced 
or causing undue discomfort. When the opening is 
not exactly closed by a properly fitting truss the omen- 
tum or intestine easily slips out, and the patient who 
wears such an apparatus is in a state of constant inse- 
curity and danger, especially if he be engaged in labor- 
ious work. There are, unfortunately, many trusses in 
the market which do not fill these requisites and expose 
the patient to the risk of strangulation, by allowing a 
portion of the intestine to escape. It would indeed be 
better for the patient that no truss should be worn 
than such a makeshift. In the words of an eminent 
specialist, it may be stated that by early mechanical 
treatment a large percentage of hernias occurring under 
middle age can be cured. This is brought about by a 
slow process of thickening and gluing together of the 
sides of the opening through which the rupture oc- 



HERNIA 337 

curred. It is advisable, however, that a truss be worn 
for at least one year after a cure has been effected. 

In ordering, especial attention should be given to 
the following points : 1. The pad should be sufficiently 
large to cover the hernial opening and extend at least 
half an inch over the surrounding parts. It should be 
made of material which will not readily absorb mois- 
ture and thus become foul and irritating to the skin. 
It should also have the proper shape, according to the 
variety of hernia, and press uniformly upon the parts. 
2. The spring should have sufficient elasticity to main- 
tain the pad in position, without undue pressure or 
chafing. 

The fitting of trusses is a much neglected art with 
physicians, and the safety and comfort of patients will 
greatly depend upon a perfect fitting appliance. This 
is doubly essential where this support is depended upon 
to make pressure during the Neoplastic process of the 
injection treatments. To have a well fitted truss, the 
following points should be observed. The patient 
should be able to place his body in any position which 
is usual, or may be unusual, in his vocation of life. He 
should lie on his back, and raise his body from the 
floor by having some one support his feet, cough vio- 
lently and persistently, bend his body forward, and try- 
to touch the floor; in fact, go through various bodily 
contortions, to be sure the truss holds firmly, and when 
you are satisfied of this, you are ready for operative- 
procedures, to effect a permanent cure. The truss 
should be worn continuously during this treatment how- 
ever, only removing the appliance during the sleeping 
•hours, and in many cases it is well to continue its use 
during the night. 

THE INJECTION TREATMENT. 

The injection treatment of hernia is purely an Am- 
erican operation,, and the credit of its discovery has 
been divided between Drs. Valpeau, Pancoast and Hea- 
ton. Dr. Warren, who has done much to perfect this 



338 HERNIA 

method, gives this honor, however, to Dr. Geo. Heaton, 
of Boston, who referred to his method as "tendonous 
irritation ;" although Dr. Heaton's treatment created 
much inquiry in medical circles, he was inclined to 
keep it a secret; it was, therefore, used by only a few 
physicians, for a number of years. About fifteen years 
ago, this method was revised and adopted by many phy- 
sicians, who are today using it, with splendid success, 
in all parts of the country. The fees attached to the 
operation have induced many physicians to commercial- 
ize the specialty by advertising. 

The injection treatment for hernia is, without a 
a doubt, as successful as other operations for hernia, 
and is the most practical and convenient for the office 
specialist, as well as the patient, for it does not detain 
the patient from the daily duties of life, and the treat- 
ments may be given in the office, with little inconveni- 
ence. The two irritant methods, and the paraffin oper- 
ation, are the only treatments which we will consider 
for office specialties. 

HERNIA FLUIDS. 

If there is any one thing the medical profession has 
been "stung" in securing the "right to use" it has been 
hernia fluids. Every promoter of a secret hernia cure 
has some special hernia fluid, which they attempt to 
extol as "superior to all others," the "only one which 
will stand the test," etc. These silver tongued medi- 
cine venders have reaped a rich harvest in fleecing 
money from the less worldly physician, by selling some 
simple fluid, with the right to use in certain localities, 
for a fancy price. The fact remains that these fluids 
are simple mixtures, which every physician has in his 
laboratory, and there is a large variety of medicines 
which will cure hernia, if properly injected. Valpeau 
and Pancost used tinct. of iodine. Roberts, of Ala- 
bama, used oil of cloves. Dr. Mason Warren used 
sulphuric ether. Heaton's injected fluid was a solution 
of quercus alba, etc. 



HERNIA 339 

The therapeutic mission of any hernia fluid is to 
create a mild irritation, without inflammation or ab- 
scess, and cause nature to throw out an abundance of 
sero-plastic lymph, which will create adhesions in the 
ruptured muscles, with complete occlusion of the her- 
nial rings, if possible. Theoretically, there are many 
remedies which may be used for this purpose. Ela- 
terium and cantharides would be the most active, but 
would require very minute quantities. 

Alcohol alone has been advocated by many ; the fol- 
lowing solution has been a favorite in my hands which 
I call: 

"X. L. C. R." HERNIA FLUID. 

If Quinine and x urea hydrochloride . . 5 gr. 

Resorcine 10 gr. 

Zinc sulphate . 10 gr. 

Guaiacol . 15 min. 

Thuja (Lloyd's tinct.) . . . . . 1 dr. 

F. E. Quercus alba . 2 dr. 

Glycerine . . . ■*;.,'. 2 dr. 

Aqua, q.s. . . . .... . . 1 oz. 

Dissolve the quinine and urea hydrochloride, the re- 
sorcine, and zinc sulphate in two drams of water ; add 
the other ingredients, and sufficient water to make one 
ounce. Thisf should stand a few days, and be shaken 
frequently; before using, filter through absorbent cot- 
ton until absolutely clear. 

In resuming the above formula, the quinine and 
urea hydrochloride is added for its prolonged anaesthetic 
effect, and to ofotund pain, during the irritant period. 
This is, also, greatly reinforced by guaiacol, with its 
irritant and antiseptic properties. Resorcine gives us 
all the advantages of carbolic acid, in a better form to 
use ; zinc sulphate, quercus alba and thuja are incorpor- 
ated for their mild irritant and astringent effects. The 
amount of this solution injected is from two to ten 
minims. 



340 HERNIA 

TECHNIQUE OF THE OPERATION/ 

Before any injections are made, you must be satis- 
fied that the patient has a well fitting truss, and one 
that will support the hernia, under all circumstances ; 
otherwise, you may be disappointed in the results, for 
this is the one essential thing in assuring success, for 
after the treatment is commenced, the rupture should 
never be allowed to protrude, even if the patient is re- 
quired to wear the truss night and day. 

After observing surgical cleanliness, of both instru- 
ments and operating area, the patient is placed upon his 
back, on a surgical table or chair, with legs flexed, and 
it is well to place a pillow under his hips, in order to 
elevate them, that the gravity of the intestines will be 




METHOD OF INJECTING THE FLUID. 

away from the canal, and not come in contact with the 
operation. Having previously filled the syringe, and 
regulated the set screw on the piston stem, for the 
amount of medicine desired for the treatment, the oper- 
ator, if right handed, should take a position at the left 
side of the patient, the forefinger of the left hand 
should be inserted in the canal of the rupture invagin- 
ating the scrotum to the. point of the internal opening : 
with the forefinger in the canal, and the thumb of the 
same hand, the tissues are lifted up so as to draw the 
tissues away from the cord, and thus avoid puncturing 
the contents. The needle is now inserted, on an angle 



HERNIA 341 

of about forty-five degrees, until the point of the needle 
reaches the finger; if the needle pricks the finger, it 
should be withdrawn back, until it avoids the scrotal 
walls ; pressure should now be gently made upon the 
piston head to force part of the contents of the syringe 
into the tissues, then the point of the needle moved to 
another place, in order that we may deposit the fluid at 
several minute areas in the canal. One of the principal 
things to be remembered is to try and deposit the fluid 
as high up in the canal as possible, for if you should 
close the canal too far down it would prevent further 
treatments, and not allow you to close the openings at 
the point desired; after the injection is made, and the 
needle withdrawn, the ~parts should be gently massaged, 
in order to scatter the medicine and cover as large an 
area as possible. The truss is now replaced, so that 
it will make constant pressure over the injected area, 
and the patient allowed to resume his daily vocations. 
This treatment i \1. .cause the patient but little in- 
convenience ; he may complain of a slight stinging or 
burning sensation, due to the mild inflammatory action. 
This will subside^in a few days, and at the end of four 
or. five days, - >r a week, the operation should be re- 
peated. 

THE AMOUNT OF MEDICINE USED. 

The amount of medicine used, and the length of 
time required to effect a cure will depend upon the 
extent of the hernia. It is always well to commence 
with the minimum amount of the fluid, and increase 
the quantity of each injection, according to the way 
the treatment agrees with the patient. I generally use 
only two or three minims, to commence with, and if it 
is borne well by the patient, increase the amount at 
subsequent treatments, always allowing sufficient time 
between each treatment for all inflammatory action to 
subside. 

The length of time required to establish the desired 
results, from this treatment, will depend upon the con- 



342 HERNIA 

dition and age of the patient, and the extent of the 
hernia. The young and vigorous wil'l respond to the 
treatment more rapidly than the feeble and aged. We 
can also obliterate a small opening with less difficulty 
than a large one. 

In order that you may observe the progress of the 
treatment, after the patient has received several injec- 
tions, a test should be made to learn how the treat- 
ment is progressing. The first test should be made 
while the patient is upon the operating table. Place 
your hands over the hernia, and request the patient to 
cough gently; if the hernia has a tendency to protrude, 
the treatment should be continued, until you are satis- 
fied that the tissues have been thoroughly united, and 
the patient can go through the different manoeuvres in 
your presence, as was done to test the truss, or are 
incident to his daily work. It is always well to have 
the patient wear the truss for some little time after 
you have discontinued the injections. This is especially 
so if the patient is doing heavy lifting. The truss may 
be entirely abandoned, however, in due time. 

THE LANGDON OPERATION. 

Dr. Langdon has devised a new method of accom- 
plishing the same results, as previously described, using 
a different means and "route" to reach the inguinal 
canal; instead of inserting the needle through the 
abdominal tissues, he has ingeniously arranged a needle 
and canula which fits over the little finger, and by in- 
vaginating the scrotum with the little finger, with this 
attachment the needle is forced through the thin scrotal 
walls, and thus deposits the medicine within the in- 
guinal canal, at a point nearest the internal opening. 
The advantages offered by this operation are as follows: 

1st, it avoids any possible danger of puncturing the 
cord, as the needle is inserted longitudinal, instead of 
transverse to the cord ; 2nd, you are more certain of 
access to the canal, as you only have to penetrate the 
thin scrotal walls. 3rd, by gently rotating the little 



HERNIA 



343 



finger, after the needle has passed through the scrotal 
walls, you produce a^ slight scarification, which also 
has a tendency to reinforce the adhesions; (although 
the latter is not advised by Dr. Langdon, the writer 
has found this procedure quite an advantage, in both 
operations). 




METHOD OF INJECTING THE FLUID IN LANGDON' S OPERATION. 




CANULA ATTACHED TO LITTLE FINGER. 

The technique of this operation is very simple ; the 
little finger containing the canula, which adheres to the 
finger by two clasps, is inserted up the canal invaginat- 
ing the scrotum the needle which has a blunt, point 
with openings" on each side is inserted through the 
canula up to, and through, the scrotal walls, and the 



344 



HERNIA 



medicine deposited at different points by rotating the 
finger. The after treatment is the same as is given in 
the former injection method. Dr. Langdon states that 
he has used at least one hundred different ingredients 
and combinations in hernia fluids, and prefers fluid 
extract of quercus alba to other injection fluids. For a 
child, up to nine years of age, he reduces the fluid 
extarct by heat, in a test tube, to one half, and injects 
from two to ten minims, using the minimum amount to 
commence with, and increasing the quantity. From 
the age of nine to twenty, he reduces the F. E. quercus 
alba, by heat, to about four tenths and adds one tenth 




LAXGDOX OPERATING SET. 



grain of zinc sulphate to each minim used. In patients 
from twenty five to seventy five years of age, he uses 
the same solution as is used for children, and adds 
one half minim of beechwood creosote to each three 
minims of quercus alba. 



HERNIA 



345 



THE PARAFFIN OPERATION. 

Paraffin has been used in the treatment of hernia, 
with marked success, by many operators, and is often 
referred to as the "supportive treatment"; the object 
of the use of paraffin is to obliterate the opening and 
canal with this neutral substance, and thus prevent the 
escape of the intestine. It also supplements the truss, 
by making pressure between the abdominal walls. 
Paraffin, used in hernia, should have a melting point 
of about 120 degrees F., and the technique of the 
operation is the same as in other injection treatments. 
The paraffin syringe is filled with the paraffin, at the 
right melting point, and when cooled to a semi-solid 
state, the finger of the left hand is inserted up the 
inguinal canal, for a guide, and the needle is forced 
through the tissues to the point where the deposit is 
desired ; the assistant operating the paraffin syringe, 
while the operator directs the deposit of paraffin, with 
the index finger of the left hand in the canal, and the 
right hand attempts to mold it into place. Of course, 
we cannot mold and manipulate the paraffin, in hernia 
operations, as we can in saddle back nose, and other 
operations, as we do not have as free access to the 
deposit. We can do much, however, in directing the 
deposit. 

The effect of the paraffin in this operation has a 
double action ; it not only acts as a support, to prevent 
the protrusion of the intestine, but also as a mild 
irritant, for while the paraffin is becoming incapsulated, 
there is an exudation of plastic material, which creates 
adhesions, and strengthens the resistance of the ab- 
dominal walls. Many operators do not advise the use 
of the truss after the operation, but the best success 
has been obtained where the truss is worn, after the 
operation, until all trace of inflammatory reaction has 
subsided ; then the results of the operation are tested, 
the same as with the irritant injection treatment. 

The paraffin treatment for hernia is slow in becom- 
ing popular, as a general operative measure, and at 



346 HERNIA 

present, is only advocated and used by a few, who 
are maintaining equal results with other hernia oper- 
ators, and fattening their purses through their exclusive 
field, and secretive methods, but we feel safe to say 
that this operation, in the near future, will receive the 
credit it justly deserves from the regular practitioner. 

By adopting any one of the foregoing methods the 
general practitioner will once more stay the hand of 
the surgeon, and prevent his hernia patients from drift- 
ing into the hands of the advertising hernia specialists, 
and retain both the glory and fees connected with the 
operation. 

To refute the charges made against the injection 
treatment for hernia, Dr. C. F. Souder, of Philadelphia, 
states : :"I can only speak from personal experience ; I 
have given nearly 16,000 such treatments without a 
death, abscess, septic infection, or atrophy of the tes- 
ticle. The treatment can be given from birth to old 
age." 

Such assurance from a man with as wide experience 
as Dr. Souder, should convince any physician regard- 
ing the reliability of the injection treatment, and al- 
though it is not indicated in all hernias, when it can 
be used it is thoroughly reliable, scientific and success- 
ful as any method in present use. When an astringent 
as well as an irritant is needed, Dr. Souder uses the 
following" in all forms of hernia : 



i * 



1$ Guaiacol 3 min. 

Creosote 3 min. 

Zinc Sulphate 3 gr. 

Fl. Ext. hamamelis 30 min. 

Glycerine 30 min. 

Alcohol 15 min. 

Inject two or three minims when reaction disap- 
pears. 



RECTUM 



347 



Rectal Diseases. 



Of the three lower orifices of the body the rectum 
is doomed to share in its percentage of diseases and 
disorders, and there are very few people indeed, who 
pass through the span of life without suffering, at 
some period, with some derangement in this part of 
their anatomy. These diseases are particularly suitable 
to incorporate in an office practice, as a large per- 
centage may be treated at the office, without detaining 
the patient from his daily duties. I will, therefore, 
only outline the treatment of such diseases of this 
organ as may be successfully operated upon, and 
treated at the office, and allow the more voluminous 
text books to discuss the theory and technique of the 
major operation, 




BRINKERHOFF'S AND PRATT'S BIVALVE SPECULUMIS WITH 
ELECTRIC LIGHT ATTACHMENTS. 

PREPARATORY TREATMENT. 

Patients who consult the physician at his office, 
regarding rectal diseases, generally possess sufficient 
pride regarding personal cleanliness to thoroughly 



348 



RECTUM 



bathe the parts before submitting to an examination; 
this is all that is necessary for a superficial examination, 
to determine the nature of the disease, but before 
conducting a thorough examination, it is best to detain 
the examination for one day, and instruct the patient 
to take light diet, and a thorough enema, and bathe 
before exploring the rectal walls. Of course this may 
be done at the office, if necessary. Your examination 
rooms should be provided with good light, and if you 
examine and treat this class of patients during the 
evening hours, I have always found it a great advan- 
tage to use a small electric light buib, attached to the 
speculum, as is illustrated here ; this is of great assist- 
ance either day or night, for general examination and 




THE OFFICE SPECIALISTS OPERATING SET. 

This makes a very convenient set for the Rectal Specialist. It contains 
four metal screw-top bottles for holding- medicines, two syringes, one 
Brinkerhoff speculum, one rectal polypus or dressing forceps, one sup- 
positor for ointments, one silver probe-pointed canula, one guarded and 
one plain hypodermic needle. 

operative work. I have provided myself with four 
speculums : Pratt's bivalve and Sigmoid. Sim's fenes- 
trated and BrinkerhofFs speculum. 

I also have the Physician's Supply Co/s rectal case. 



RECTUM 349 

illustrated here, which contains nearly all the instru- 
ments for treating rectal diseases, and will be found 
indispensable to any office specialist. 

LOCAL ANAESTHESIA. 

After determining the nature of the disease you 
have to deal with, and suggest an operation, about the 
first question the patient will ask you is, "must I 
take chloroform or ether"? and what a world of signifi- 
cance that little word "no" has, as it comes from the 
lips of the physician, for once more we have conquered 
pain in the treatment of these painful afflictions, and 
our old friend Quinine and Urea hydrochloride is 
monarch of the territory it surveys. 

Dr. Gant was the first to abandon cocaine and other 
toxic anaesthetics, and prove that local anaesthesia 
could be produced by infiltrating the operative area 
with sterile water; by reinforcing his method with the 
addition of a one half to a one per cent quinine and 
Urea hydrochloride, we can produce a perfect anaes- 
thesia for nearly all rectal operations. 

The -technique for producing anaesthesia will depend 
upon the extent of the operation. In the operation for 
a simple fissure, it is only necessary to infiltrate the 
tissues under the surface ; where complete anaesthesia 
of the rectal area is desired, the entire rectal walls 
should be completely anaesthetized ; for this purpose 
I use the following solution : 

Quinine and Urea hydrochloride 5 gr. 

Aqua dis 1 oz. 

*' Sterilize the water by boiling, and when nearly 
cool, add the quinine and urea hydrochloride. 

When we wish to make an incision through the 
skin and subcutaneous tissue, as in fistula, colostomy 
for hemorrhoidal operations, etc., the following tech- 
nique will completely anaesthetize the operative area: 
Commence by pinching up a fold of skin at the line of 
incision and press firmly with the thumb and fore- 
finger. This will lessen the pain caused by the needle,. 



350 



RECTUM 



which is now inserted between the layers of the skin, 
and a few drops of the anaesthetic slowly injected; 
the needle is now inserted further and more anaesthetic 
used. This is followed until the entire operative area 
is distended, to resemble a water blister. Care should 
be exercised not to inject through the skin in this 
treatment, as it is only intended to obtund the skin. 
When you have anaesthetized the external surface 
which may require about one syringe full of the 




METHOD OF INJECTING THE LOCAL ANAESTHETIC. 

anaesthetic, the deeper structures may be anaesthetized 
by injecting directly into the tissues, without further 
pain ; therefore, to completely anaesthetize the entire 
rectal area, at least four more injections are made. 
These injections should be made external to the 
sphincter muscles, thus avoiding the diseased area and 
large blood vessels of the rectum. I usually divide the 
surface into four punctures: one at the top and bottom 
of the median line, and one at each side, as is illus- 



RECTUM 351 

trated here. During these injections the index finger 
of the left hand is inserted into the rectum, as a guide 
to the needle, and to prevent puncturing the inside 
walls, as the needle is inserted. Pressure is made upon 
the piston to deposit the anaesthetic at different points, 
and after the needle is withdrawn, the injected area is 
massaged with the finger within the rectum. One 
hypodermic syringe full of the anaesthetic, injected at 
these four points, as a rule, will produce' complete 
anaesthesia; if you should fail, more of the anaesthetic 
should be used. The sphincter may now be dilated 
by the use of the mechanical vibrator, using vibratode 
P. and the lateral stroke, or with the speculum, and 
we are prepared for nearly any operation upon the 
anus or rectum. 

CONSTIPATION. 

While constipation is the primary cause of a large 
number of rectal diseases, it is also a great menace by 
retarding any curative measures we may adopt for 
their relief; therefore, when this condition exists in 
connection with rectal disorders, our first step towards 
success will be to restore the dormant bowels to new 
life and activity. The causes of constipation are. mani- 
fold; it may be hereditary, or due to indigestion, etc., 
but the most frequent cause is simple neglect. 'Many 
people are so little concerned regarding their health 
that they will not find time to answer nature's call, 
and by continuing this neglect, in due time they not 
only find themselves afflicted with rectal disease, but 
often many other bodily ailments, as the result of 
absorbing toxic influences, which should be eliminated 
each day; therefore, the physician's first step towards 
success, in treating diseases of the rectum, is to 
"educate his patients to educate their bowels," and 
thus remove the cause. This, in many cases, is all that 
is required to effect a cure, not only of rectal diseases, 
but many other constitutional ailments. This condi- 
tion is of such frequent occurrence that it requires 
more than passing notice. 



352 RECTUM 

There is much said in medical literature regarding 
''intestinal atony." I am inclined to believe, however, 
that the "atony" is located in the rectum more fre- 
quently than in the upper bowel, for direct treatment to 
the rectum will result in a permanent cure far more 
rapidly than when medication is directed otherwise. 
Retention of faeces in the rectum results in -over dis- 
tention, and thus weakens the walls by permanent 
dilation. This "plug" of faecal matter is particularly 
conducive to congesting the pelvic organs, by obstruct- 
ing the return circulation, thus producing varicose 
veins or hemorrhoids, as well as displacements of the 
female organs, and other pelvic and constitutional dis- 
orders. Of all the treatments devised for the cure of 
chronic constipation, those directed to the rectum 
proper have been the most successful. Simple dilation 
of the sphincter,, with graded rectal dilators, will give 
excellent results, as far as overcoming- the tension of 




RECTAL ELECTRODE. 

the muscles is concerned, but this is not all that is 
required. Above these muscles we have a large pouch, 
formed by broken down muscular fibers, due to the 
continuous expansion of the rectal walls. This is the 
point where treatment is directed, with the best results 
for "atony," and the best means of restoring tonicity 
to these walls is by mechanical vibration and electricity. 

We have already referred to vibrotherapy for con- 
stipation on page 91, to which you are referred. 

To overcome the atony of the muscular walls of the 
rectum, electricity excels every other means. The 
modified Morton wave current described by Dr. Rice 
as follows: "The patient sits upon a chair on an 
isolated platform ; ground the negative side of the 



RECTUM 353 

machine to a water pipe or gas fixture. Connect to 
the latter the medium-sized condensers, and close the 
switch; the short rectal electrode, illustrated above, 
well lubricated and inserted. The conducting cord is 
connected to the top of the condensor, on the positive 
side of the machine ; the prime conductors are closed, 
and the machine started slowly, gradually separating 
the former until the patient feels the current at the 
side of the electrode; this current is allowed to pass 
about two minutes, and then increase the length of the 
spark gap to from four to six inches. 

If the prime conductors are separated gradually, 
there will be neither pain nor discomfort during or 
after the treatment. This treatment should be given 
for fifteen minutes ; if it is followed by mechanical 
vibration, ten minutes is sufficient. These treatments 
should be given daily, at first, and lengthen the inter- 
vals, as the treatment progresses. 

Many hygienic and physical measures can be 
adopted with excellent results. Patients who are con- 
stipated should drink plenty of water, two or three 
glasses of water before breakfast, and at intervals dur- 
ing the day, with regular hours to go to stool, (prefer- 
ably after breakfast), with plenty of exercise, for those 
of sedentary habits, will relieve many cases. Our 
Materia Medica is congested with remedies advocated 
for constipation, and nostrum venders continue to 
herald their literature for candy carthartics and laxa- 
tives, until today we have thousands of pronounced 
victims of the pill habit. Drugs should be used as 
sparingly as possible, although they may be used to a 
good advantage in commencing treatment. Of the 
entire list, there are only three worthy of much praise 
for chronic constipation, although many may be given 
for temporary relief. 

Fl. ext. Cascara Sagrada heads the list, and by rein- 
forcing this remedy with nux vomica and phenol- 
phthalein, we may obtain permanent results, if judic- 
iously used, as follows : 



354 



RECTUM 



^ Phenolphtalein 1 dr. 

Fl. ext. nux vomica 1 dr. 

Fl. ext. cascara sagrada ..... 1 oz. 

Simple elixir q. s 4oz. 

Mix. Sig. A teaspoonful three times a day. 
I supply the patient with the above mixture, and 
another eight-ounce bottle of simple elixir, and each 
day, as he takes the three drams from the four-ounce 
bottle, he refills it with the simple elixir; in this way, 
it is gradually reducing the amount of medicine used, 
and by the time it is exhausted, he is taking very little 
medicine, and is relieved from constipation. By follow- 
ing this rule, and instructing the patient regarding a 
regular hour for stool, diet, drinking water, exercise, 
etc., we can cure the majority of cases. I never pro- 
nounce these cases cured, however, until they can tell 
the time of day by nature's calling them to stool. 
Thev have thus svstematized their habits. 




FIG. 1. DIAGRAM OF NERVE SUPPLY OF ANUS. 
FIG. 2. FISSURE OF THE ANUS UNFOLDED. 

FISSURE. 

This may be defined as '"'the biggest little disease" 
of the rectum, or perhaps the entire body ; for there 
are few diseases involving so little space, which create 



RECTUM 



355 



such intense pain and gravely reflex disturbances as this 
innocent looking abrasion, at the muco-cutaneous border 
of the anal orifice. By referring to the minute anatomy, 
(see accompanying illustration), we find this area more 




DIAGRAM OF NERVE TRUNKS WHICH ARE CONCERNED IN 
PRODUCING REFLEX SPASM, 
a. Fissure, c. Sensory nerve, d. Motor nerve, e. Pudic. f. Ischiadic, 
g. Ilio-lumbar. h. n. Lumbar, i. Spinal center. 



than abundantly supplied with nerve fibers, which are 
laid bare by this rupture of the mucous membrane, 
which are more sensitive to touch than the eye. 

Owing to the pain and discomfort endured by the 



356 RECTUM 

patient, the treatment of fissure has always demanded 
a large fee for its relief, by the unprincipled rectal 
specialists, who would greatly magnify the seriousness 
of the disease for the purpose of depleting their victims' 
purse. This is one of those little diseases where pain 
predominates, and "surgical operation is the only means 
of relief," and the patient is willing to pay almost any 
price to be relieved of his suffering. The fact is, the 
treatment of fissure is as simple as the disease itself. 
The first thing to accomplish is to relieve constipation, 
which is present in the majority of cases. Many of 
the superficial fissures may be cured by keeping the 
bowels in a semi-solid state, and applying pure carbolic 
acid to the full length of the fissure. Complete dilata- 
tion of the sphincter muscles, to the full extent of a 
Pratt's bivalve speculum, or the older way of inserting 
the thumbs, of both hands, into the rectum, and stretch- 
ing the muscles to their full extent will produce a 
temporary paralysis and displace the exposed nerve 
fibers. This, followed with scarification of the open 
surface, and the application of aristol, or other anti- 
septic dressings, will give immediate relief, and cure 
nearly every case. 

A popular, and what may be called "up-to-date" 
method, is by producing complete local anaesthesia 
with quinine and urea hydrochloride, and dilating the 
sphincter by pressing vibratode P., (page 85), well 
against the anus, using the lateral stroke until com- 
plete relaxations exist; the ulcer may now be dissected 
away, and the edges united with the required number 
of sutures. The bowels should be tied up. for a few 
days, in order to permit healing, and the after treat- 
ment directed to keep the bowels open. 

ABSCESS AND FISTULA. 

Rectal abscess and fistula are of the most common 
occurrence ; in fact, some authors have given this the 
first rank in rectal diseases, believing it to be more 
common than hemorrhoids. These diseases are so 



RECTUM 



357 



closely related that it would be almost impossible to 
discuss them separately, as fistula is the result of 
abscess, in ninety per cent of all cases, and only a few 
consult the physician until the fistula has formed, and 
when once formed it has little tendency to heal spon- 
taneously. Where an abscess has formed, there is only 
one treatment, which is to make an incision, and re- 
move the pus, and treat as an abscess in other parts 
of the body; if treated early, this may avoid the forma- 
tion of fistula by rapidly healing. The majority of 
cases, however, present themselves after the fistula has 
formed. There is little or no pain, and the chief 
annoyance to the patient is the continual discharge from 
the unhealed sinus. 



5"?fSS"j 




..-:■'■. 'V- - 



DIFFERENT FORMiS OF FISTULA. 

Fistula has been classified as complete when it has 
a sinus leading from the rectum to the outer skin, (see 
accompanying illustration) (1), internal, incomplete 
when the opening leads to the rectum, (2) external, 
incomplete when the opening is to the outside surface 
alone, (3) and the complex, or horseshoe variety, which 
is complicated with one internal opening, with two or 



358 RECTUM 

more external sinuses, (4). The first step towards 
treatment is to determine the character of the fistula 
we have to deal with ; with the index finger in the 
rectum, and a silver probe, it is not a difficult thing to 
learn the nature of the fistula. Colored injections have 
been made in the external openings to determine the 
location of the internal exit. The use of the speculum 
or a well trained finger will, however, locate the pa- 
pillae, which opens to the sinus. 

NON-OPERATIVE TREATMENT. 

To cure fistula, without the use of the knife, is the 
method advertised by the local, irregular and itinerant 
specialists, and is the method preferred by most pa- 
tients. "*No knife and no detention from business'' is 
the catchy caption ; words which draw patients to their 
offices. It is well, therefore, to become familiar with 
their "tricks." 

There are two principal things which prevent a fis- 
tula from healing spontaneously; the first, is the ten- 
dency of the external opening to heal, and prevent 
free drainage of septic fluids, and second the inlet of 
septic material through the internal opening. Over- 
coming these two obstacles has been the principal 
reason why these physicians have been so successful 
with non-surgical treatments. 

Away back in the days of the Senior Brinkerhofr", 
when skilled rectal surgeons were few, and "quack pile 
doctors" were predominating, we find these rules most 
closely Observed, and they have done much to favor 
the present non-surgical treatment of today. It will, 
therefore, be seen that absolute cleanliness, asepsis. 
and treatment to destroy old tissue, and promote the 
development of new granulations, is the method 
directed towards results; although the medication may 
improve as chemistry advances. 



RECTUM 359 

TECHNIQUE OF OPERATION. 

The patient should be prepared as for any rectal 
operation, and the nature of the fistula determined. 
A local anaesthesia is used, if desired, in sensitive 
patients, as the use of quinine and urea hydrochloride 
will avoid much of the post operative distress. 

The external opening is dilated with a small flexible 
bougie, to provide free drainage, and extent of the fis- 
tula outlined. A medium sized syringe, with flexible 
silver probe, pointed canula, page 364, is filled with 
peroxide of hydrogen, and injected deep into the sinus, 
and every effort made to reach its most remote parts 
by massage ; after the froth has escaped, the sinus 
should be irrigated with plain water, and a saturated 
solution of nitrate of silver is injected in the same 
manner, completely covering the abscessed walls. 
Great care should be exercised that the solution is 
injected into the cavity, and not into the tissues ; there- 
fore, a pointed needle should be avoided. In order to 
prevent the escape of the fluid into the rectum, where 
it may be absorbed and produce destructive effects to 
the walls, and constitutional symptoms, the index finger, 
covered with the rubber shield, (to prevent staining the 
fingers), is inserted into the rectum, and pressed firmly 
against the internal opening. The external opening is 
protected by lubricating the skin with vaseline. The 
solution of silver should be allowed to remain a short 
time, and the parts massaged to reach al! sections of 
the tract. After the silver solution escapes, it is some- 
times well to dilate the external opening with a flexible 
bougie, to provide free drainage. In a few days, the 
diseased, living tissue, will slough away, and be replaced 
by healthy granulations. This may completely oblit- 
erate the canal. If it does not, the parts still left open 
may be treated in the same manner, in a few days, 
until the operation is successful. The original "Brink- 
erhoff System" used the following solution, instead of 
silver nitrate, known as "Ulcer Specific." 



360 RECTUM 

I£ Dis. ext. Hamamelis 5 dr. 

Liq. fe'r. subsulph 1 dr. 

Acid carbol, cryst ; . ; 2 g-r. 

Glycerine 2 dr. 

Dr. Mathews makes this method more energetic by 
dilating the sinus with a laminaria tent, and then in- 
serts an Otis urethrotome, and both dilates and scarifies 
the interior of the sinus, to promote healing. Scarlet 
red medicinal is the latest remedy advocated for the 
injection treatment of fistula. 



METALLIC CATAPHORESIS TREATMENT. 

This is also a very successful treatment, and is 
particularly suitable for office practice, as it does not 
detain the patient from his daily duties. A probe 
pointed copper wire electrode, attached to the positive 
pole, is inserted into the fistula track, so as to cover 
the entire surface, as near as possible. The index 
finger is inserted into the rectum, .as a guide and to 
prevent the electrode to penetrate the internal opening, 
and contact with the opposite wall of the rectum. The 



e^ 



PROBE POINTED COPPER WIRE ELECTRODE. 

negative pole is attached to the pad electrode, and 
placed upon the back or abdomen, and from five to 
twenty milliamperes used, according to. the extent of 
the fistula covered, and the diameter of the electrode. 
The current is used for about ten minutes ; the elec- 
trode is now removed with some force, as it has become 
attached to the walls of the diseased tissue, which is 
removed with the electrode, leaving in the fistula track, 
healthy tissue, which will unite and close the canal. 
There are many surgical procedures for the treatment 
of fistula, with which most physicians are familiar; we 
will, therefore, not discuss them here. 



RECTUM 



361 



HEMORRHOIDS. 



Hemorrhoids have been classified as internal and ex- 
ternal. The internal are those which originate above 
the verge of the anus and the external below; the in- 
ternal being subdivided into venous and capillary, and 
the external into thrombotic ; and tags of skin, or they 
may present a complicated condition of both internal 
and external, as is illustrated here. 

The character of hemorrhoids may be easily diag- 
nosed by having the patient strain as at stool. A large 
percentage of hemorrhoids may be treated and cured at 
the office, by the various methods of treatment we have 



.,Mm . 




.' 






M 


. 


...■ ■ ■<;•■' 



INTERNAL AND EXTERNAL HEMORRHOIDS. 

at our disposal. The most unfavorable variety are those 
situated high up in the rectum and difficult to reach. 
These, however, may be treated to reduce the inflam- 
mation, and operated upon later, since we have such 
absolute control over pain by the use of local anaes- 
thetics, there are very few cases indeed which can not 
be restored to health by office treatments. 

The treatment of hemorrhoids is directed to pallia- 
tive measures, for the temporary relief of the patient, 
and those which permanently destroy the tumors. 
Hemorrhoids, like other diseases, have a tendency to 
cure spontaneously, or at least subside, so as to cause 
the patient little or no inconvenience. The main ob- 



362 



RECTUM 



stacle to overcome is constipation, and the use of 
cathartics, especially aloes, which more than any other 
remedy congests this organ. 

Suppositories for the relief and cure of hemorrhoids 
constitutes one of the oldest treatments, and much good 
may be accomplished from this medication. The fol- 
lowing is of exceptional value in mild cases, and will 
give the patient immediate relief, providing we relieve 
the constipation and straining at stool. Each supposi- 
tory contains : 



"I 



% 




'Mm, 




SECTIONAL VIEW OF EXTERNAL AND INTERNAL HEMORRHOIDS. 



If Quinine and Urea Hydrochloride . . 1 gr. 

Ext. Belladonna ....... y 2 gr. 

Ext. Hamamelis 1 gr. 

Bismuth sub. nit 2 gr. 

Tannic acid Yi gr. 

Cocoa butter , . . 20 gr. 

Sig. Apply a suppository into the rectal cavity two 
or three times a day. 

In resuming the therapeutic value of the above 
formula, the Quinine and Urea Hydrochloride and Bel- 
ladonna are given for their obtundant and anodyne ef- 
fects. The Hamamelis for its specific influence upon 
the venous blood vessels, the bismuth and tannic acid 



RECTUM 363 

for their astringent effect to strengthen the walls of the 
rectum. I have often been surprised at the expressions 
of gratitude received from patients, who have used this 
suppository, but in order to obtain the best results full 
doses from five to ten grains of phenolphthelein should 
be giveai, if the patient is constipated, to clear the 
bowel of impacted faeces, and allow the bowels to 
move with the least possible straining. In fact, they 
should be so loose as to run off without straining at 
all, and thus avoid the protrusion of the pile tumors. 

THE INJECTION TREATMENT FOR 
HEMORRHOIDS. 

This is another method of treatment which was 
ushered into the healing art under the clouds of mys- 
tery, and was formerly considered one of the "tricks" 
in the Medical World. It was slow in being kindly ac- 
cepted by the regular physician, when first introduced, 
but the venders of the "system" were successful in 
placing this method in the hands of the less skillful 
physicians, until the entire country was swarmed with 
itinerant "Pile Doctors," who were puncturing the piles 
and purses of patients by the hundreds. Then the 
Medical press commenced its campaign regarding the 
bad results from the treatment. 

The fact is, the injection treatment for hemorrhoids 
is not the dangerous operation it was pictured to be, 
and the articles published, by jealous physicians, re- 
garding deaths from emboli, carbolic acid poisoning, 
etc., have very little weight when this method is used 
by skilled hands. Unfortunately, the "systems" were 
sold to many ignorant men, who were not physicians, 
and entirely destitute of a sound Medical knowledge, 
yet in their hands, the success obtained was remarkable, 
under the circumstances. 

TECHNIQUE OF THE OPERATION. 

Prepare the patient as previously described, and he 
may be placed upon his side or back, as is most con- 
venient for the operator; by requesting the patient to 



364 RECTUM 

strain, as if at stool, he may force the tumors outside 
the sphincter muscles; if he is unable to do so, an 
enema of warm water may be given at the office, which 
will assist in forcing the hemorrhoids in full view of 
the operator. The tumors should now be bathed, and 
vaseline applied to the tumors and mucous membrane, 
to prevent any injury. If the injection fluicf should 
overflow, and come in contact with the external sur- 
face, the syringe having a guarded needle, (see illus- 
tration), is rilled with the following solution: 

I£ Carbolic acid . . 1 dr. 

Glycerine . . . ... , . . ' . 1 dr. 

The needle is now forced into the border of the 
tumor at its longitudinal diameter to the opposite side, 
being careful not to puncture the opposite wall, which 
is previously regulated by the guard on the needle, and 
as the needle is withdrawn, pressure is made upon the 






GUARDED NEEDLE AND CANUDA. 

piston to deposit the medicine. The amount of medi- 
cine used will depend upon the size of the tumors, and 
should be regulated by the set screw on the piston 
stem before inserting the needle. This will vary from 
one to two minims for small, and four or five for the 
larger tumors. It is always best to treat the small 
tumors first, as they are more accessible than they are 
later, after the large tumors have been destroyed. 

After the injection is made, and the cauterization is 
completed, it will be observed that the tumors are of a 
pale bluish color, which indicates that the cauterization 
has been successful. They should be lubricated with 
vaseline, and placed within the bowel. If it is impos- 
sible to force the tumors outside the sphincter muscle 
by straining, and for the tumors higher up in the bowel. 



RECTUM 365 

the Brinkerhoff speculum is used to throw them in 
view. 

The bowels should be tied up for a few days with 
morphine, and when they should move a full dose of 
phenolphthalein should be given, to produce a profuse 
watery stool, without straining. Never inject over two 
small, or One large tumor at each treatment, and at the 
end of ten days or two weeks, continue the operation 
at these periods, until they are all eradicated. 

In summing up this operation, it might be compared 
with the injection treatment for hernia; they have both 
been more or less condemned by surgeons who wish to 
"knife" every case they come in contact with, yet the 
physicians who practice these methods are optimistic 
to their attack, and silently, yet successfully, cure their 
patients, and reap the remunerative rewards attached 
to the operation. It is rather amusing to read the ar- 
ticles of some noted surgeon, condemning this treatment 
as an unscientific and barbarous procedure, and later, 
hear them boast of the results they have accomplished 
by pinching these delicate tissues in a clamp, and sear- 
ing them with a hot iron; it is true that both methods 
destroy the tumors by cauterization ; one can be done at 
the physician's office, with little or no pain, the other 
requires profound anaesthesia : but, really, which method 
belongs to the barbaric ages of antiquity? 

By observing the following notes regarding this 
treatment, you will be rewarded with success. If the 
piles or rectum are inflamed, reduce the inflammation 
by the use of the suppository, and other treatments 
previously given. Always see that the colon is un- 
loaded before operating. Never use less than a 50 per- 
cent carbolic acid solution, for the stronger the solution, 
the more complete the cauterization; inject under the 
tumor, and not into it, and do not try to accomplish 
too much at one treatment. One or two tumors is 
enough to treat at one time, and be sure that alb sore- 
ness has disappeared from the preceding operation be- 
fore continuing further treatment. 



366 



RECTUM 



CLAMP AND SUTURE OPERATION. 

Where surgery is resorted to, the best operation for 
office treatment consists of the clamp and suture. This 
is conducted by thoroughly anaesthetizing the operative 
area with Quinine and Urea Hydrochloride, as prev- 
iously described. The sphincters are thoroughly dilated, 
either by mechanical vibration or the speculum, and the 
tumors brought to view; the parts are thoroughly 
bathed, and made aseptic as possible. The notched 
clamp is clasped about the tumor, and the hemorrhoids 
cut off, at the border of the clamp ; the sutures are now 
made between the notches, uniting the borders of the 
wound with catgut. This gives us a clean surgical 
operation, which is nearly bloodless and painless, and 
we have so completely closed the wound as to prevent 
post operative hemorrhage; the sutures are absorbed in 
due time, and will cause very little detention, if any. 
from business. This operation is applicable to all forms 
of internal or external piles, or the mixed variety. 




CLAMP AND SUTURES APPLIED. 



EXTERNAL HEMORRHOIDS. 

Thrombotic hemorrhoids are caused by a rupture of 
a vein, and the extravasation of blood, which forms into 
a clot of a bluish color, and extremely painful. This 
may be clasped in the clamp, as described above, or if 
accessible, this is not necessary. A fine incision is 
made, and the clot rolled out, and the edges united with 
sutures. Tags of skin may sometimes be present, in 
large quantities, either as the result of thrombotic piles, 
or irritation from constipation and straining at stool. 
These small tumors may be injected with cocaine, and 



RFXTUM 



367 



clipped off with scissors ; if large, a suture applied to 
prevent bleeding. 

PRURITIS ANI. 

This is another one of those, apparently little, 
diseases which annoy the patient to the border of in- 
sanity, through the irritation it creates, the loss of 
sleep, worry, etc. 

A few years ago,' I was consulted by a patient who 
had been afflicted with this disease, for about two years ; 
he stated: "Doctor, I believe I have bugs around the 
rectum." He described a typical case of Pruritis, and I 
determined to treat his case purely from a parasitic 
origin. I therefore, gave him a box of blue ointment, 
reduced one-half with vaseline, and directed him to 
apply it three or four times a day; he used the contents 
of the box; and although he has been constantly under 
my observation, the disease has never returned, to my 
knowledge. This is only one case in hundreds, where 
this simple treatment has proven effective in relieving 
this condition. Whether or not this disease is caused 
by a parasite, I am satisfied that treatment directed to 




THROMBOTIC HEMORRHOID. 

this cause is more satisfactory than other methods of 
treatment. In extreme cases, I use the ecorchement 
treatment, as described on page 111, which thoroughly 
removes all the old skin, which has become like parch- 
ment, and involves the nerve filaments through con- 
tinuous irritation. This will also prove very effective 
in stubborn cases. 



368 ALCOHOLISM 



Alcoholism and the Drug; 
Habits. 



Once more we are confronted with this great ques- 
tion : What can we do to reclaim the drunkard and drug 
habituate? There are only two ways of solving the 
great problem. The first is to absolutely prohibit the 
manufacture and sale of intoxicating liquors and habit- 
forming drugs ; then we may tell that mythful fellow, 
the Devil, to bank his fires, and turn Hell into a cold 
storage plant, for his domicile will be as destitute as a 
spider's web in January. The great good accomplished 
by prohibitory laws has been demonstrated in many 
states, yet until these laws become universal, and in- 
volve the entire union, the drunkard and habituate are 
like "The poor ye have always with ye," and our second 
and only recourse is Medical assistance in the hands of 
physicians, to restore these shattered inebriates to 
normal manhood, by a combination of psychic, moral 
and medical measures. 

The treatment of alcoholism and the drug habits 
was ushered into popularity under the limelights of 
"mysterious medicine," and for a number of years the 
so-called "gold cure Institutes" have reaped a golden 
harvest for their treatment of these unfortunate victims. 
In my former publication, the "Secrets of Specialists," 
I endeavored to expose the methods used at many of 
these Institutes, but following the trend of American 
custom in attempting to accomplish ten days labor in 
twenty-four hours time, has been adopted at several 
Institutes, and now we have the Gatlin three-day cure 
for alcoholism and the Swan three-day cure for drug 
habits, etc. It is, therefore, well to discuss some of the 
modern methods used in treatment of these conditions. 



ALCOHOLISM 369 

ALCOHOLISM. 

There has been much discussion in Medical litera- 
ture whether or not alcoholism is a- habit or disease. 
I am inclined to think it is both, according to the stage 
and length of time alcohol has been consumed by the 
patient. I do not believe that any man was born with 
a natural appetite for liquor, and the first taste of 
liquor, except wine and cordials, was anything but pal- 
atable to the taste, but the rum shops, or a hell holes," 
(would be a better name for the places they choose to 
call cafes), with their glittering lights, music, songs and 
dances, from half crazy men, offer just enough induce- 
ment to awaken the young American's curiosity, which 
finally develops a taste for liquor, and the habit of 
drinking. When the system becomes saturated with 
the poison its secondary effect is to create disease, by 
shattering nerve force, resulting in paralysis, petrifying 
tissues, producing sclerosis of the liver and other or- 
gans, and thus producing a chain of bodily ailments, as 
a direct cause of alcoholism. 

There are three distinct stages, or classes, of alcohol 
habituates ; the first, where there is no particular desire 
or appetite for liquor, but the victim will perhaps lick 
his wife, or meet with business disappointments, and 
celebrate the occasion by becoming intoxicated. These 
are the most difficult cases to treat successfully, as there 
is no foundation for treatment. The second class are 
those who consume a certain amount of liquor each 
day until it, apparently, becomes a food to them, and 
they keep their shattered nerves ''steamed up" con- 
tinuously, without any noticeable effect. The. third 
class wish to consume all the liquor to which they have 
access, and are really whiskey degenerates. The two 
latter classes are the ones where Medical treatment will 
derive its greatest benefits. We will, therefore, not 
discuss -these classifications as disease, but outline some 
of the latest methods of treatment, and their indications 
for specific results. 



370 ALCOHOLISM 

THE TREATMENT. • 

It is after a debauch, a periodical or prolonged spree, 
that the drunkard generally presents himself for Medi- 
cal assistance, and it is at this period he is most easily 
influenced to pursue a prolonged course of treatment, 
with a view of permanently abandoning his habits ; he 
is, at this time, disgusted with himself and the world, 
and the situation of affairs is well described by Riley in 
the following lines: 

"When a man ain't got a cent an' he's feelin' kind o' 

blue, 
And the clouds hang dark and heavy an' won't let the 

sunshine through, 
It's a great thing, O my* brethren, for a fellow just to 

lay 
His hand upon your shoulder in a friendly sort o' way. 

It makes a man feel curious ; it makes the tear drops 

start, 
An' you sort o' feel a flutter in the region o' your heart, 
You can't look up an' meet his eye ; you don't know 

what to say, 
When his hand is on your shoulder in a friendly sort 

o' way. 

Oh, the world's a curious compound with its honey and 

its gall, 
With its care and bitter crosses, but a good world 

after all. 
An' a good God must have made it — leastways that's 

what I say 
When a hands rests on your shoulder in a friendly sort 

o' way. 

It is at this psychological period that the hand of a 
physician on his shoulder, "in that friendly sort o' way,'' 
can do the most good in pointing out the demoralizing 
influence his habits have reflected upon himself and 
family, and the majority of cases will submit to nearly 



ALCOHOLISM 371 

any form of treatment, if they are assured it will be of 
permanent benefit to them. 

The first step regarding treatment is therefore the 
"sobering up" process, or the recuperative treatment. 
There is one remedy that bears a greater influence than 
all others as an antidote for alcohol. This is ammonium 
chloride in full doses, one-half to one dram dissolved 
in water, given in one dose, and followed by a copious 
draught of water. This will not only counteract the 
effects of the alcohol,, and sober up the patient quickly, 
but will prevent delirium, which often follows alcohol 
debauches and overcome the craving for alcoholic stim- 
ulants. If there are symptoms of delirium, which are 
not removed by this remedy, full doses of veronal 
should be given, together with bromides, and other hyp- 
notics ; hyoscine is the best remedy for desperate cases. 
We want the patient to sleep sound, and long, and 
when he awakens the craving for alcohol has generally 
disappeared. If he should still crave for the stimulant, 
it is now the very best time to give him an emetic, to- 
gether with a full drink of whiskey. A hypodermic 
injection of % grain of apomorphine, after he has taken 
the whiskey, will of course, make the patient very sick, 
and he will vomit profusely. This may seem like a 
rather heroic measure, but it will do more good at this 
time than any other, and the chances are that the pa- 
tient cannot even bear the smell of whiskey, to say 
nothing of tasting it, after he has passed through this 
ordeal. This is the process known as the "barber pole 
shot," at many "gold cure Institutes," and although we 
are practicing deception by making the patient believe 
that he cannot take whiskey and your treatment at the 
same time, as your medication is a complete antagonist 
to all forms of liquors ; although apomorphine is the 
best emetic, others can be substituted, and given in the 
whiskey if desired, but I am thoroughly convinced that 
the sickening process is the best form of treatment that 
can be given. Deception or no deception, it will bear 
its lasting influence upon the patient and do more good. 



372 ALCOHOLISM 

later, in having the patient totally abstain from drink- 
ing, than any means at our disposal, and the best time 
to use this means is early in the treatment, for after 
this period has passed, the patient is practically cured, 
as the only treatment is to restore his appetite, recon- 
struct his shattered nervous system, and eliminate the 
remnants of the toxic influence of alcoholism. He 
should now be encouraged to eat little, and often, and 
within a few days his appetite will return ; his bowels 
should be kept open, and a systematic course of baths 
given for eliminative purposes. The following is the 
general routine of treatment I pursue : I direct the 
patient to take "the pill that will," (Cannabin com- 
pound, page 328), every two or three hours. The Can- 
nabin in this pill is just sufficient to keep his nerves 
steady, and relieve his tremor and restlessness, while 
the balance of the medications the pill contains are 
reconstructive, and nerve tonics, of a superior quality, 
every drug having a direct influence upon his broken 
down system. In combination with this pill, the pa- 
tient is given a teaspoonful of the following mixture 
after each meal : 

J£ Acetate of potassium 4 dr. 

Nux vomica (F. E.) . . . . . . 1 dr. 

Com. fl. ext. Cinchonia 1 oz. 

Aromatic F. E. Cascara Sagrada . q.s. 4 oz. 

This medication is given for its diuretic, tonic, and 
laxative effect. I also give the patient a five-grain cap- 
sule of sodium glycocholate before retiring. This is the 
one remedy in our possession for the congested liver 
of alcoholism, following a debauch. If there is any one 
organ of the body which suffers from the continuous 
use of alcohol it is the liver; it becomes so "parched" 
by its use that sclerosis may be the final result, and 
even at this stage, a five-grain capsule of sodium gly- 
cocholate, three times a day, will often cure seemingly 
hopeless cases. Baths constitute one of the most im- 
portant eliminative measures, and the ''boiling out" 
process will accomplish even more than medicine, in 



ALCOHOLISM 373 

the final treatment of eradicating the body of the toxic 
influence of alcohol. The best bath for this purpose 
is the electric light bath. The patient should be re- 
quired to take this bath each day, during the treatment, 
followed by a salt glow and body massage. The time 
required to conduct the above treatment should occupy 
at least three or four weeks, until we are satisfied that 
there is no desire for alcohol, and the body has elim- 
inated, as far as possible, all traces of alcohol. There 
are several organized companies ; prominent among 
these is the Gatlin Institute, which guarantee; to ac- 
complish, in three days, what we have accomplished 
by the foregoing treatment in three weeks. The 
catchy caption of "three day cure" was, no doubt, 
designed for the purpose of corraling the business 
man,- or men who would like to abandon alcohol 
secretly, but does not care to spend the time, or enjoy 
(?) the publicity of leaving home, or being an inmate 
at a so-called Gold Cure Institute. 

While we may commend the Gatling gun as a 
rapid fire arm, we can only condemn the Gatlin treat-' 
ment as a rapid armament against alcoholism. The 
only rapid accomplishment it possesses is the transfer 
of money from the victim to the treasurer of the con- 
cern. One of these Institutes is located only a few 
blocks from my office, and I have carefully observed 
the results of their treatment, which may be summed 
up in two words — purgatives and emetics. I had 
occasion to visit one of the inmates during the second 
day of his treatment, and he informed me that he had 
"been vomited and purged at least fifteen times that 
day." The fact is, the wonderful discoverer of this 
treatment, no doubt, realized that the more rapidly he 
could make his patient sick at his stomach, he would 
incidentally, make him sick of whiskey, if given with 
the emetic; whether the emetic would be apomorphine. 
ipecac, or tartar emetic. The purging process also 
offers the patient a source of amusement It keeps his 
time occupied, and just think of it, at the end of three 



374 ALCOHOLISM 

days the patient is discharged, cured This treatment 
may be used as a preliminary measure, but the recon- 
structive and eliminative treatment I have previously 
given is of the greatest importance in removing the 
toxic influence of alcohol. 

THE DRUG HABITS. 

Fully eighty per cent, of the adult population of the 
world are addicted to the use of some form of drug. 
This may seem like an exaggerated statement; never- 
theless it is true. Nearly every nation has their Na- 
tional beverage, which is pregnant with intoxicating 
alkaloids, and it is the alkaloids that the people really 
crave. The bitter infusion from tea leaves would nor 
interest people; it is the theine that produces the "cup 
of cheer." The aroma from coffee would lose its flavor 
if it were not for the caffeine it contains. The people 
of Peru would not esteem the cocoa leaves if it were 
not for the exhilarating cocaine contained in them. 
These are, therefore, the most universally adopted bev- 
erages. If it should become a custom, Cannabis Indica. 

• Hyoscyamus, opium and other drugs would be used in 
the same manner, yet while habitues of the latter are 
looked upon as mortals possessed with the evil spirit, 
the hostess of a fashionable tea party is upheld as a 
princess De Luxe ; yet, in reality, they are addicted to 
drugs ; the only difference is the form of drug, and the 
effect the excessive use produces. 

There seems to be a natural desire among the 
human family to crave almost any drug which will pro- 
duce an abnormal condition of the brain ; on the other 
hand, we find habits formed for the most unusual 

'things. 

During my speculative years in medicine I accepted 
a position as physician in charge of one of the "Gold 
Cure Institutes," for the purpose of learning their 
"tricks." During my six months' stay I was surprised 
at the number of people who presented themselves with 
the different and unusual habits. There was one case 
with the lead pencil habit. This beautiful young lady 



ALCOHOLISM 375 

was a clerk in a dry goods store, and acquired the 
habit of eating lead pencils, which she said she could 
not resist. She presented all the characteristic symp- 
toms of lead poisoning, with the leaden hue complexion, 
etc. There were two cases with the clove habits, 
which shows that it is not only the exhilarating and 
narcotic effect of drugs some appetites crave for; yet 
the narcotics and cerebral stimulants are the most fre- 
quent of drug forming habits. 

After adopting nearly every system for the treat- 
ment of the drug habits, I am thoroughly convinced 
that the gradual reduction method is the safest and 
easiest way for patients to abandon their habits. Be- 
fore attempting to treat any form of the drug habits, 
the first thing for a physician to accomplish is to estab- 
lish the utmost confidence of the patient. He should 
have a heart-to-heart talk with the patient, and demand 
the consent of his faithful co-operation; otherwise, the 
cure will terminate in a failure. The patient should 
promise that he will not, under any consideration, take 
his accustomed drug, only as it is dispensed to him by 
you. If this rule is made rigid and' faithfully observed, 
the physician should promise in return that he will not 
allow his patient to suffer undue agony for the want of 
his drug. Drug habitues are an extremely secretive lot, 
and unless the utmost confidence is established between 
patient and physician, it will be observed, during the 
treatment, that the patient is taking the drug he has 
secreted for emergency purposes. It is well to N advise 
the patient that he will suffer some little distress, but 
in due time this will pass over, and he will finally 
experience no desire whatever. 

It might be said that there can be no routine method 
of treatment for abandoning the drug habit, as each 
individual case is a law unto itself, and presents char- 
acteristics and idiosyncrasies which require individual 
attention. The physician's judgment and skill is often 
taxed to bridge over these obstacles as they arise, and 
endeavor to point the pathway towards success ;' to ac- 



376 ALCOHOLISM 

complish this, extreme effort should be made to see 
that the patient takes less of the drug each day during 
the treatment. Just the length of time required can 
never be determined beforehand, but will depend upon 
the length of time the patient has taken the drug, and 
his physical condition, and all treatment should be 
directed to build up his physical condition, in propor- 
tion to the amount of drug withdrawn. A hospital or 
sanitarium is the best place to conduct the treatment, 
as you can have the patient under your constant care 
and observation ; although cases may be successfully 
treated in private practice, providing you can trust 
them. 

THE GRADUAL REDUCTION METHOD. 

Upon the hypothesis that the patient is a favorable 
subject, and does not take the drug for the purpose of 
suppressing pain or organic disease, and his confidence 
is gained, he should be requested to hand you all the 
drug in his possession, and syringe, if administered 
hypodermically. If the accustomed drug should be 
morphine, and the patient was in the habit of using 
thirty grains each day, I endeavor to reduce this 
amount the first day to one-half, making a basis of fif- 
teen grains, to commence the treatment. The patient 
will, withstand this reduction very nicely, as a rule. I 
now attempt to reduce the drug one grain each day, 
for eight days ; for the next seven days, the drug is re- 
duced one-half grain; thus, at the end of the first two 
weeks, we have reduced the drug from thirty to three 
and one-half grains. The next week I attempt to re- 
duce the drug one-half grain each day, and at the end 
of the third week, if the treatment has been successful, 
the drug is given up altogether. These rules should 
be adhered to as closely as possible ; although it is fre- 
quently necessary to stretch the last end of the treat- 
ment a few days longer, and if possible, withdraw the 
drug several days before the patient is aware of it. 

The method of preparing the treatment is very sim- 
ple. I always weigh out the amount of morphine or 



ALCOHOLISM 377 

cocaine, or whatever the drug may be. In the above 
case, it would be fifteen grains the first day, fourteen 
the next day, and so on down to the minute doses. 
This is dissolved in an ounce bottle of simple elixir, 
and the doses are given according to the patient's reg- 
ular custom, in divided amounts. If the patient was in 
the habit of taking the drug at four different periods 
of the day, two teaspoonfuls of the elixir was given at 
each period, and towards the end of the treatment, 
quinine is substituted for morphine to disguise the bit- 
ter taste. 

Of course many complications will arise during a 
course of treatment, but the foregoing is the easiest 
and best way for the patient to abandon the drug, and 
the complications can readily be mastered by the physi- 
cian. Throughout the treatment, the patient should 
be encouraged to be brave, manly and hopeful to meet 
the enemy, and "Fight it out on this line," forever. All 
the eliminative measures used in the treatment of alco- 
holism are of equal or more importance with the drug 
habits. 

The patient should take electric light or Turkish 
baths throughout, and after the treatment. The bow- 
els should be kept active, with the formula given on 
page 372. The liver, as well as the entire glandular 
system, has been clogged by the use of the drug, and 
requires stimulation, and the glycocholate of sodium, in 
five grain capsules, before retiring, is our most effec- 
tive remedy. Insomnia can generally be overcome by 
the use of veronal or hyoscine. You will not experi- 
ence much difficulty in meeting the complications with 
the gradual reduction method, as the body has suffi- 
cient time to become accustomed to the conditions 
produced by withdrawing the drug. It is the rapid 
withdrawal method which produces grave results, and 
alarming symptoms. Analogous to the Gatlin three- 
day cure for alcoholism, a physician, named Swan, orig- 
inated the "three-day cure" for the morphine habit. 
This was first put in practice only a few doors from my 
office, and later a company was formed, and located in 



378 ALCOHOLISM 

Cleveland. This, and similar reduction methods, was 
fully exposed in my former publication, "The Secrets 
of the specialists," and consists of substituting hyoscine 
for morphine, and keeping the patient in a narcotic and 
semi-conscious state for a few days. This, and Livin- 
stein's method, and Dr. Mattison's plan to substitute 
large doses of bromides for morphine, are too cruel to 
be practiced by any human physician. And if any phy- 
sician wishes an enemy for life, he may attempt the 
use of these methods. The advantage of the gradual 
withdrawal method is that it may be used with equal 
results for morphine, cocaine, hyoscine, chloral or any 
other drug, and if successful, you will have the ever- 
lasting gratitude of your patient. 



EYE, NOSE AND THROAT 



379 



Diseases of the Eye, Nose and 
Throat 



The diseases incorporated under the above caption 
have constituted the oldest of single or combined spe- 
cialties, and there are so many valuable and exhaustive 
text books upon the subjects that no attempt will be 
made, in this chapter, to cover the field. I will, there- 
fore, only point out what may be considered some of the 
unusual methods of treatment, which will be of much 
service to the general practitioner. No physician should 




A PRACTICAL $12.50 NEBULIZING OUTFIT. 

think of conducting an office practice, or sanitarium, 
without installing a nebulizer or atomizer outfit ; or, 
some may prefer the more elaborate apparatus known 
as the Inhalatorium. These may be obtained at prices 
ranging from $12.50 to several hundred dollars. The 
small nebulizer, represented here, will render equal ser- 
vice to the more expensive apparatus, but is not as con- 
venient for the physician, or elaborate to please the 
eye of the patient. In connection with either of these 
apparatus, the physician should provide himself with a 
trial case for fitting glasses. This is a very "profitable"' 



380 



EYE, NOSE AND THROAT 




A MODERN NEBULIZING OUTFIT. 



EYE, NOSE AND THROAT 381 

branch of office work, which really belongs to the phy- 
sician, but has been monopolized by jewelers, who 
know little or nothing regarding the anatomy, physi- 
ology, and diseases of the eye ; but tinker eyes upon the 
same principle they do watches. Any physician can 
acquire a skillful knowledge of refraction in a short 
time, which will be the means of adding several hun- 
dred dollars to his yearly income. Physicians can like- 
wise treat many of the simple diseases of the nose and 
throat, with equal results, to the city specialists, and 
the time devoted to the study of these chronic diseases 
will prove to be one of your most valuable of profes- 
sional assets 

OCULAR THERAPEUTICS. 

If I were only allowed one remedy for the treat- 
ment of the diseases of the eye, I would unhesitatingly 
choose oil of thuja, as it will accomplish better results, 
in a larger range of eye diseases, than any one remedy 
in our possession. 

Although thuja has been extensively used by our 
eclectic brothers for years, very little has been said 
regarding its use in diseases of the eye, except by 
Homeopathic physicians. This, no doubt, has been 
due to the difficulty in finding a suitable form in which 
to dispense this drug to the sensitive and delicate mem- 
branes of the eye. Alcoholic extracts have, of course, 
been excluded on account of the irritation they produce, 
and the oil of thuja I refer to is not the volatile oil of 
camphoraceous odor found on the market, which is pro- 
duced by the distillization of thuja in water, but an 
artificial oil, prepared by distilling thuja in olive, or 
other vegetable oils, by a special process. This gives 
us a suitable menstruum in which we may receive the 
full value of this drug, Without producing an irritation, 
as is characteristic with other preparations of thuja. 
One of the earliest uses of thuja was its action for re- 
straint, and reduction of hypermetrophic changes in 
mucous and cutaneous tissues. It will deaden and re- 
press fungous granulations, and has a marked action 
on such granulations as those of trachoma. 



332 EYE, NOSE AND THROAT 

In this disease, thuja cannot be overestimated, as 
one drop of this oil, applied to the eye three or four 
times a day, will often produce the most remarkable 
results. Corneal ulcers and opacities are often, appar- 
ently, absorbed, and vanish like magic, as do cystic 
growths and pterygium, sclerotic and palpebral con- 
junctivitis. In fact, it is the first remedy I think of in 
all forms of acute or chronic inflammation, and as a 
solvent for corneal opacities, growths, etc. 

I sometimes think that physicians become stereo- 
typed in their methods of treatment, and this would 
well describe my attitude in the use of oil of thuja in 
the treatment of many diseases of the eye. 

When the therapeutic action of any single remedy 
becomes so firmly fixed upon a physician's mind, that 
he considers it almost a panacea, the practice of medi- 
cine loses its scientific aspect ; yet after prescribing this 
remedy for the large variety of classified diseases, in 
which it seems indicated, and observing its therapeutic 
value, we must accept the truth, and I believe the oil 
of thuja will not disappoint reasonable expectations, in 
the treatment of a large number of the diseases of the 
eye than any one remedy in our possession. Thuja is 
slightly anodyne, stimulant, antiseptic, alterative and 
tonic, and when applied to the eye in the form of a 
non-irritating oil, it will remove the granulations, and 
subdue inflammation in tracoma and conjunctivitis. It 
will often remove pterygium, and the diffuse nebula, or 
the more dense form called macula, which follows cor- 
neal ulcers. In fact, it is the first remedy to be thought 
of in all acute and low forms of inflammation, and cor- 
neal opacities of the eye, and the best of all, it can be 
applied by the patients at their own home with little 
or no inconvenience. I usually provide patients with 
a drachm vial, and a medicine dropper, and instruct 
them to apply one drop, three times a day. The pa- 
tient should lie down, to retain the oil in the eye, and 
after it has been applied, massage the eye over the 
closed lids. 

Dioxix is another drug which has a unique position 



EYE, NOSE AND THROAT 383 

among ophthalmic remedies. This remedy is one of 
the products of opium, and occurs as a white, odorless, 
bitter powder, soluble in seven parts of water. This 
drug is a powerful optical analgesic and lymphagogue. 
It is superior to cocaine in the treatment of many 
painful affections of the eye, although it is not a local 
anesthetic, as is cocaine, as sensibility is not affected 
but its analgesic effects, in the treatment of many su- 
perficial, and deep seated inflammatory and painful 
affections, as iritis iridocyclitis, glaucoma, ulcers, pain 
and inflammation of the cornea, giv^s it an independent, 
therapeutic value in a large range of application. 

Dionin is also a lymphagogue. It produces redness, 
and a very marked vascular dilation, with abundant 
lacrymal secretions. The lymphatic channels become 
distended to several times the size of their normal cal- 
iber, thus removing inflammatory exudates, and replac- 
ing the tissue with healthy tissue. In this respect, it 
has been referred to as a counter irritant, and belong- 
ing to the same category as Jequirity, in increasing 
lymphatosis. Dionin is applied to the eye in the form 
of dry powder, or in aqueous solution, ranging from 2 
to 10 per cent, according to the effect desired. When 
stronger than a five per cent, solution is used, Lacri- 
mation and chemosis of the conjunctiva, and swelling 
of the eyelids, are characteristics of its use. 

As an analgesic, in all painful affections of the eye, 
Dionin has no superior, in its action upon inflamed mu- 
cous surfaces, and is particularly indicated in the deep 
seated pains, such as accompany glaucoma iritis, irido- 
cyclitis, etc., while in iritis it has a threefold effect; 
relieving the pain, hastens the absorption of exudates, 
and assists atropine in dilating the , pupil. 

In interstitial keratitis it will hasten resolution and 
rapid healing, and clear the cornea under its influence. 
Konigstein believes that Dionin is abortive of paren- 
chymatous keratitis, if used in the early stages, but 
valueless in the later stages. 

In resuming the therapeutic value of dionin for the 
diseases of the eye, its first indication is for the relief 



384 EYE, NOSE AND THROAT 

of all pain in the eye, either the superficial or deep 
seated. One-quarter to one-half grain of the dry pow- 
der, or one to two drops of a five to ten per cent, solu- 
tion, installed in the conjunctival sac, and followed 
with massage will be attended with some pain; this 
will subside, however, in a short time, and suppress all 
pain, which will last from four to eight hours, when the 
powder, or above a five per cent, solution is used. It 
will be followed with chemosis of the conjunctiva, 
which may frighten the patient, if not forewarned. This 
need cause no alarm, however, as it will rapidly sub- 
side, and is even an appearance to be welcomed, as it 
is in these cases we receive its greatest analgesic effects, 
and as the apparent irritation it produces subsides, it 
has a tendency to remove inflammatory exudates, and 
remove disease. We have, therefore, produced a mild 
form of disease for the purpose of removing a more 
serious condition, and this may be compared to the 
results of vaccination in the treatment of smallpox. 

Cineraria Maritina has obtained- quite a widespread 
reputation as a solvent for cataract. This remedy is 
imported from South America, by some concern in 
Georgia, and is sold to physicians at $1.25 per drachm 
vial, which is about. one month's treatment. By plac- 
ing one drop of this remedy in the conjunctival sac, 
and massaging the eye, there have been many favorable 
reports given, where it has restored sight by removing 
the obstruction to vision; while the principal sphere of 
action concerning this remedy seems to center as a 
solvent for cataract, it has been recommended for other 
ocular diseases, corneal ulceration and opacities, injur- 
ies to the eyelid, conjunctiva or cornea iritis, catarrhal 
or muco-purulent conjunctivis, inflammation of the 
lachrymal gland or of the cellular tissues of the orbit 
trachama, and in fact, any condition of the eye where 
an absorbent antiseptic is desired. 



EYE, NOSE AND THROAT 



385 



Throat and Nose Medications. 



Dr. Carl Seller, of Philadelphia, 
has become very well known as 
the author of certain antiseptic 
preparations. Seller's Antiseptic 
Wash is made after the follow- 
ing- formula: 
B Sodium bicarbonate.... 8 dr. 

Borax 8 dr. 

Sodium benzoate 20 gr. 

Sodium salicylate 20 gr. 

Eucalyptol 10 gr. 

Thymol 10 gr. 

Menthol 5 gr. 

Oil wintergreen 6 min. 

Glycerine 8 % fl. oz. 

Alcohol 2 fl. oz. 

Water q. s. ad. 16 pints. 

Dr. Seiler gives these direc- 
tions for preparing the com- 
pound: Dissolve all the volatile 
ingredients in the alcohol, rub 
up the solution with the sodium 
salts, and dissolve in the water, 
finally adding the glycerine. Al- 
low to stand in a large bottle 
w^li occasionally shaking for at 
least two weeks before dispens- 
ing. Dr. Seiler has placed on 
the market also his Antiseptic 
Tablets, which, dissolved in 
water, produce a solution similar 
to the above. 
B Sod. bicarb 1 oz. 

Sor). boratis 10 oz. 

Sod. chlorid 1 oz. 

Sig. : Add a teaspoonful to a 
pint of lukewarm water and use 
with a syringe or atomizer to 
cleanse the nose from thick 
mucus and crusts. 
B Sod. bicarb 15 gr. 

Sod. biborate 15 gr. 

Acid carbol 4 gr. 

Glycerin 15 min. 

Aquae ad 1 oz. 

Sig.: Dobell's solution. Dilute 
with eaual parts of water and 
use with atomizer or snuff up 
the nose. Simple cleansing solu- 
tion. 
B j^cidi acetici 2^ dr. 

Glycerin 3 dr. 

Aqupp 10 oz. 

Sig.: To be used as an antisep- 
tic and stimulating wash in the 
nose and nasopharynx in the 
course of the exanthematous 
fevers. 
B Acidi carbolici 30 gr. 

Ammoni carbonatis 1 oz. 

Pulv. carbonis ligni. . . .1 oz. 

Olie lavandulae. . . . . .20 min. 

Tinct. benzoin comp.. . % oz. 
Sig.: Uncork and inhale to re- 
lieve the congested condition of 
the mucous membrane in acute 
coryza and hay fever. 
B Acid carbolici 30 gr. 



Ext. pini canadenis 

dest. ,> 20 min. 

Liq. vaselin 1 oz. 

Sig.: To be used in acute stage 
of hay fever for the anesthetic 
effect of the carbolic acid. 

— (Ingals.) 
B Acid chromici cryst. . . ^ gr. 

Aquae 1 oz. 

Sig.: Ft. nebulae and use to 
check sneezing. 

I£ Eucalyptol 15 min. 

Menthol 15 gr. 

Camphor 15 gr. 

Ol. pini compilonis. . . . V2 dr. 

Ol. roasae 2 min. 

Liq. vaselin, q. s. ad....2oz. 
Sig.: Use in the nose with an 
atomizer in mild cases of hyper- 
trophic rhinitis. 

B Ichthyol 48 gr. 

Lanolin 4 dr. 

Vaselin 4 dr. 

Sig.: Use on a cotton-wound 
applicator to massage the nasal 
mucous membrane in chronic 
forms of rhinitis. 
B Hydrarg. ammoniati.. . .4 gr. 

Pulv. sach. albi. y 2 oz. 

Sig.: Insufflate into the nose 
to Stimulate the mucous mem- 
brane in ozaena. 

B . Antipyrin 15 gr. 

Aquae ad 1 oz. 

Sig.: To be used in the nose 
and throat as a hemostatic. 
B Pulv. fol. matico. 

Pulv. amyl. excic, aa equal 
parts. M. 
Sig.: To be insufflated into the. 
nose for epistaxis. 
B Glycerit. acid, tannici . .3 dr. 

Aquae ad 3 oz. 

Sig.: One teaspoonful to a*. 
wineglassful of warm water, to- 
be injected in the nose night and 
morning, as a remedy for post- 
nasal adenoids. 

B Iodini '. 10 gr.. 

Pot. iodidi,.... 10 gr. 

Ol. gaulther 5 min. 

Glycerin 1 oz. 

Make four solutions, varying 
the amount of iodine and potas- 
sium iodide between the limits 
given in the prescription. 

Sig.: In dry rhinitis, pharyn- 
gitis, and laryngitis, begin with 
the weakest solution and grad- 
ually increase to the strongest 
to stimulate- the glandular func- 
tion of the mucous membrane. 

B Guaiacol 4 dr. 

Olive oil 4 dr. 

Sig.: Apply to the fauces of 
pharynx in acute tonsillitis and 
pharyngitis. 

B Argent, nitrat 4 dr. 

Aquae dest 4 dr. 



386 



EYE, NOSE AND THROAT 



Sig.: It may be used instead of 
the guaiacol mixture. One or 
two applications of the above 
mixture are often sufficient to 
arrest acute inflammations of 
the throat and pharynx if ap- 
plied in the first stage. 

R Guaiacol y 2 oz. 

Ol. amygdalae dulcis. . . y 2 oz. 

Sig.: To be applied with a 
cotton-wound probe in acute in- 
flammation of the throat. It is 
also applied to relieve pain. 

I* Tr. iodi 1 dr. 

Glycerine Vz oz. 

Aquae 3 oz. 

Sig.: To be used to moisten 
compress in laryngitis. 

R Eucalyptol 10 min. 

Menthol 5 gr. 

Camphor 5 gr. 

Liq. vaselin q. s. 5 oz. 

Sig.: To be used in acute 
laryngitis after cleansing the 
throat with aqueous solutions. 
R Menthol 48 gr. 

Ol. olive ....q. s. 1 oz. 

Sig.: To be applied to the 
larynx in laryngeal tuberculosis 
with a cotton-wound applicator, 
or atomizer. — (Rosenberg.) 
R Ol. eucalyptol 2 dr. 

Ol. terebinth 1 dr. 

Magnesise carb. levis...2dr. 

Aquae q. s. 3 oz. 

Sig.: A teaspoonful in a pint of 
hot water. Inhale the vapor to 
loosen the secretion and allay 
the cough in tubercular laryn- 
gitis. 
R Quininae sulphatis y 2 gr. 

Acid carbolici % gr. 

Extract, krameriae. . . . y 2 gr. 

Pep 2 gr. 

Sig.: Take one before each 
meal at which meat is taken in 
cases where there is sluggish 
digestion with flatulency. This 
is of special value for vocalists, 
actors, and speakers, in whom 
the digestive system is fre- 
quently impaired by nervous- 
ness. 
R Potassii chloratis 2 dr. 

Glycerin 2 dr. 

Aquae 10 oz. 

Sig.: Use as mouth-wash in 
syphilis during the administration 
of mercury. 
R Liq. hydrarg. nitratis . . . 4 dr. 

Aquae q. s. 1 oz. 

Sig.: To be applied to the 
sloughing ulcers of tertiary syp- 
hilis. As the application is very 
painful, cocaine should first be 
applied. 
R Sodi. bicarb 10 gr. 

Glycerine 1 dr. 

Aquae ad 4 dr. 



Sig.: Drop in the ear three 
times daily to soften inspissated 
cerumen preparatory to removing 
with a syringe. 

R Hydrozone (15 vol.) 3 dr. 

Aquae . .- • 3 dr. 

Sig.: Use same as preceding. 
R Acidi carbolic (1-5 per cent 

1 oz. 

Glycerine 1 oz. 

Sig.: Drop into ear to relieve 
pain in middle-ear inflammation. 
R Peroxide of hydrogen. . .1 oz. 

Sig. : A few drops into ear in 
middle-ear suppuration. 
R Camphor (reduced to a fine 
powder with a few drops 
of rectified spirits) .... 1 oz. 

Chloral hydrate 1 oz. 

Sig.: To be applied externally 
as an anesthetic in neuralgic and 
other affections of the throat. 
R Hydrarg. oxidi rubri. . . . 4 gr. 

Pulv. sacch. albi y 2 oz. 

Sig.: To be blown into the nose 
after cleansing in ozaena. 

R Iodof ormi 10 gr. 

Menthol 5 gr. 

Lanolin y 2 oz. 

Liq. vaselin y 2 oz. 

Ft. ung. Sig.: To be applied to 
the interior of the nose with a 
brush in ozaena or ulcer of the 
septum. 

R Creolin 4 min. 

Aquae 1 oz. 

Sig. : Antiseptic and deodorant, 
to be used in atrophic rhinitis, 
syphilitic and other ulcerations, 
and in diseases of the accessory 
sinuses. 
R Sanguinariae canadens. . . 1 dr. 

Aquae tepid 1 oz. 

Ft. lotio. Sig.: To be used with 
an atomizer or syringe morning 
and night for ozaena. 

R Zinc sozoiodol 48 gr. 

Talc q. s. 1 oz. 

Sig.: To be blown into the nose 
in atrophic rhinitis after cleans- 
ing the nose from crusts. 

R Menthol 48 gr. 

Toluol 2 dr. 

Sol. perchloride iron. ... 1 dr. 

Alcohol absolute 1 oz. 

Sig.: To be applied locally in 

diphtheria or pseudodiphtheria. 

— (.Loffler.) 

R Acid lactici 1 dr. 

Aquae 1 oz. 

Sig.: To be used with an ato- 
mizer in diphtheria as a solvent 
of the membranous exudate. 

— (L. Browne.) 

R Acid sulphurosi % oz. 

Aquae 10 oz. 



EYE, NOSE AND THROAT 387 

Sig. : To be used as gargle in Sig.: To be blown into the nares 
diphtheria, pseudodiphtheria, and in empyemia of the accessory sin- 
in mycosis. By some it is con- uses. 

sidered as almost specific in j^ Aluminis 1 dr. 

diphtheria. Acidi tanni'c'i .' ! ! '.'.'. '.'.'.'.'.. 1 dr." 

B. Bristol, Aquae rosea 10 oz. 

Nosoohen' Si £- : To be used as a gargle in 

Iodol ' relaxation of the uvula and con- 

Iodof'orm gestion of the fauces. 



388 THE DISPENSARY 



The Dispensary 

If I were to choose a text for this chapter, I would 
quote from the man whom the late Colonel Ingersoll 
has referred to as "an intellectual ocean whose waves 
touch every shore of thought," — Shakespeare — says: 

"Who steals my purse steals trash ; 'tis something, noth- 
ing; 
'Twas mine, 'tis his, and has been slave to thousands, 
But he that filches from me my good name, 
Robs me of that which not enriches him, 
And makes me poor indeed." 

Rojas has said: "It is the enemy whom we do not 
suspect who is the most dangerous." I will adopt the 
Roman sentiment, however, that "it is more honorable 
to save the citizen than kill the enemy." I will, there- 
fore, endeavor to point out the enemies who are steal- 
ing both the physician's purse and his good name, and 
allow the physician to choose the method of disposing 
of the evil. 

Some physicians do not seem to realize the disad- 
vantages under which they are laboring, both profes- 
sionally and financially, by not dispensing their own 
medicines, and there are very few physicians indeed 
who do not require all the financial and professional 
support obtainable ; and by dispensing his own medi- 
cines he not only enriches his purse, but he keeps his 
professional knowledge within the walls of his cranium, 
and it does not become the common property of the 
common people, as it does in the hands of the unscrup- 
ulous drug clerk, who assumes the name "Doc," and 
dispenses the same prescription to Smith, Jones and 
Brown. It really is like "casting pearls before swine" 
to place your prescription in some pharmacist's hands. 



THE DISPENSARY 389 

I do not wish to be understood as condemning the con- 
scientious druggist, but I do wish to condemn the prac- 
tice of refilling prescriptions promiscuously, and with- 
out the consent of the physician who has prescribed it 
for some specific purpose. 

To illustrate one of the most frequent instances, I 
will briefly cite the following case, which is familiar 
with most physicians: 

The physician writes a prescription for Mr. Brown, 
for gonorrhoea. The physician's fee is $1.00 ; the drug- 
gist charges $1.00 for the medicine which costs 25 cents. 
The physician has now lost 75 cents by not supplying 
the medicine. The patient meets the physician in a 
few weeks, and advises him that he has had the pre- 
scription refilled five times, (pleasant news?); this is 
$3-.75 more profit for the druggist, and loss for the phy- 
sician. Brown is now cured, and meets his friend 
Jones, who has the same affliction. Brown advises 
Jones to go to Doc, the druggist, and have the same 
prescription filled, and thus an endless chain has been 
formed. The prescription has become the common 
property of "Doc the Druggist," and filed away among 
his private belongings, while the physician wonders 
why he is living in such a moral community, and re- 
sults of social evils or "errors" do not present them- 
selves. This is one of the most common forms of prac- 
tice, and counter prescribing is not confined to any one 
class of diseases, for many druggists have prescriptions 
for every known ailment, and are stealing both the 
purse and good name of the physician, under the pseu- 
donym, "Doc." 

There is an old adage "a dollar saved is a dollar 
earned," and the foregoing is not the only method by 
which the physician loses money, by not dispensing his 
own medicines. The next kind of classified thief, who 
steals his purse, is the manufacturer of proprietary and 
semi-proprietary medicines, who profusely supplies the 
physicians with samples, which they claim to be inde- 
pendent chemical products, and, in reality, are only 
compounds of our cheapest chemicals. This is well 



390 THE DISPENSARY 

illustrated by the many acetanilid preparations, which 
in former years, have been offered to the medical pro- 
fession, under coined names. If we can accept the 
report of reputable chemists, we find the original form- 
ula of Antikamnia, ammonol, etc., to depend upon ace- 
tanilid for their active principle. This, combined with 
a still less expensive product, sodium bicarbonate, was 
sold to physicians at $1.00 per oz., and, according to 
the published formula of Antikamnia ,as it was before 
the pure food and drug law, it contained acetanilid 70 
parts, sodium bicarbonate 20 parts, and caffeine 10 
parts. Now, supposing the physician had compounded 
his own Antikamnia, according to the following form- 
ula, at the present market price of chemicals, as fol- 
lows: 

I£ Acetanilid 1 lb. cost 32 cents 

Sodium bicarbonate ... 4 oz. cost 4 cents 
Caffeine . . . . . .2 oz. cost 68 cents 

Total $1.04 
It will be seen by the above figures that the physi- 
cian would be receiving 22 ounces of the finished pro- 
duct for, approximately, the same price he paid for one 
ounce of Antikamnia. (It has been stated that acet- 
phetetidin has replaced acetanilid in the above antikam- 
nia formula). 

Many of the pharmaceutical products are manufac- 
tured at nearly the same excessive profit. Take Pea- 
cock's Bromides as an example. It is claimed by the 
manufacturers that each fluid drachm contains 15 grains 
of the Combined Bromides of Potassium, Sodium, Am- 
monium, Calcium and Lithium; at the present market 
price, these chemicals may be obtained at the following 
prices : 

I£ Potassium Bromide 1 lb. 29 conts 

Sodium Bromide 1 lb. 40 cents 

Ammonium Bromide .... lib. 44 cents 
Calcium Bromide ^ lb. 28 cents 



THE DISPENSARY 3Q1 

Lithium Bromide . . . . . ^ lb- 90 cents 
Aromatic Elixir, q. s 1 gal. 50 cents 

Total $2.81 
The above is approximately the same formula as 
Peacock's. Each fluid drachm represents 1.5 grains of 
the combined bromides, but instead of paying $1.00 for 
an eight ounce bottle, as we do for Peacock's product, 
we are buying sixteen, eight ounce bottles for $2.81, or 
less than 20 cents each. 

Now we will take Bromidia: this is sold in four- 
ounce bottles, for $1.00 per bottle. Each dram con- 
tains 15 grains of chloral hydrate and 15 grains of bro- 
mides. By adding four pounds of chloral hydrate, at 
$1.06 per pound, or $4.24, add this to the elixir of 
bromides given above, and we have one gallon of 
Bromidia, at a total cost of $7.05, or 3i2 four-ounce bot- 
tles, which have cost us about 22- cents each, and Bat- 
tle & Co. have the courage to ask $1.00 for, substanti- 
ally, the same product. 

While the trade motto of the Peacock Chemical Co. 
is "the purity of Bromides," the Antiphlogistine Co. has 
chosen the trade phrase of "bleed but save the blood." 
I am inclined to favor the last phraseology, as there is 
no doubt the physician is being bled, and the company 
is saving the blood. The cataplasm of kaolin, of the 
U. S. P. is supposed to be similar to antiphlogistine; 
the formula is as follows : 

Kaolin, very fine powder .... 9% oz. 
Boric acid 
Thymol 

Methyl Salicylate 
Oil of peppermint 
Glycerine 

Heat the Kaolin in a suitable vessel at 100 degrees 
C, with occasional stirring for one hour; mix it intim- 
ately with the acid, and incorporate thoroughly with 
the glycerine; finally add the thymol, which has been 
previously dissolved in the methyl salicylate and oil, 
and make a homogeneous mass. 



Y\ oz. 


4 


g r - 


15 


gr : 


6 


mim 


6 


oz. 



392 THE DISPENSARY 

This will produce every result accomplished by the 
"Denver Mud," and will cost you less than one-fourth 
the price asked for their semi-secret article. 

There is still another class of chemical sharks who 
require a watchdog to guard the safety of the physi- 
cian's treasury; they are the aristocratic chemical fakirs 
who coin names for legitimate chemicals, and attempt 
to place them in the hands of physicians at a fancy 
price, under their own trade labels; to illustrate, when 
Hexamethylenamine was introduced into the therapeutic 
world as an antiseptic, to the genito-urinary and intes- 
tinal tract, it was at once marketed under several trade 
names, viz. : Urotropin, Formin, Cystogen, etc., with 
varying prices. You can buy Hexamethylenamine for 
$1.00 a pound, but when you buy the same chemical 
product, under the trade name "Urotropin" you pay 
sixty cents an ounce or $7.20 a pound. You may secure 
all the Acetylsalicylic acid you desire for $2.40 per 
pound, but when you secure the same product under 
the trade name of "Aspirin" you pay forty-three cents 
an ounce or $5.16 a pound. Phenacetine is now listed 
at 33 cents an ounce, but when you buy the same pro- 
duct under its correct chemical name — acetphenetidin — 
you are only required to pay $1.05 for a pound, and 
you save $2.91 a pound, and so we could go on through 
long list of chemicals and show you the way physi- 
cians have been robbed of their purses from this source. 
The pharmacists have "become wise" to this, and if 
you will visit most of their dispensing cases, you will 
find your "aspirin" prescriptions have been filled from 
containers labeled acetylsalicylic acid, which is correct, 
but they no doubt will receive aspirin prices. 

I am not attempting to be personal or unjust to any 
pseudo chemical company, for they are all alike, as far 
as the profit is concerned, and all the physician has to 
do is take his pencil and figure out the enormous profit 
these specialty chemical and drug companies make. . 

The general physicians' supply houses, chemical and 
pharmaceutical companies, etc., who furnish a general 



THE DISPENSARY 393 

line of supplies, including chemicals, drugs, tablets, 
elixirs, etc., are therefore, the ones to deal with. 

THE COST OF DRUGS. 

If a physician was engaged in the mercantile busi- 
ness, the first information he would seek to learn would 
be where he could buy the best goods for the least 
money, but through his professional weakness, he has 
accepted St. Paul's advice to "Take what is set before 
him, and ask no questions." Therefore, the first step 
towards success is to become familiar with the drug 
market, and the cost of drugs, and inasmuch as this 
chapter is published for its practical information, I will 
give a list of the supplies and catalogues which every 
physician should have in his laboratory; these may be 
called the plans and specifications for his work shop, 
and the drugs and chemicals, the tools of his profes- 
sion. 

Every physician, who dispenses his own medicines, 
should have either the National or U. S. Dispensatory, 
and also the National formula; Maltbie's Practical Phar- 
macy is an excellent little book of reference for the dis- 
pensing physicians, and the Physicians' Drug News, 
published at Newark, N. J., not only keeps you in- 
formed regarding the current prices of drugs, but its 
columns are open to supply physicians with information 
how to compound difficult pharmaceutical preparations, 
and private formulas, so they will be palatable, com- 
patible and correct.- This journal also publishes each 
year hundreds of excellent formulas for physicians' use, 
who dispense their own medicines. In fact it is the 
journal for the dispensing physician. 

Another indispensable book is "Merck's Index. " 
This most excellent book, of over four hundred pages, 
is neatly bound in cloth, and sold to physicians for the 
modest sum of forty cents, which is less than it costs 
to publish the volume, and its actual worth is beyond 
estimation ; therefore, send forty cents to 'Merck & Co., 
New York City, this very day for this publication ; also 



394 THE DISPENSARY 

request Merck & Co. to send you their current price 
list of chemicals, alkaloids, new remedies, etc. With 
these two Merck publications you have a complete 
working compendium regarding the details, and cost of 
drugs. Now when some "Specialty" chemical or drug 
company floods your mail with literature regarding 
some product they manufacture, (or have manufactured 
for them), before paying the enormous price they may 
ask, find out what you could manufacture it for your- 
self, the same as we have Antikamnia and other pro- 
ducts in the foregoing pages. 

Under no consideration should any physician pre- 
scribe any remedy unless it is supplied with an open 
face formula, for it places him on an equal basis with 
the lowest forms of medicine venders ; most of the' spe- 
cialty chemical companies attempt to publish their 
formulas, however, in such a way as to blind the phy- 
sician. Such products should find everlasting rest in 
the waste basket. -When names are coined for legiti- 
mate chemical products, the cost may be figured out as 
follows : For years, physicians have been required to 
pay $1.80 per ounce for Aristol, which is a trade-mark 
or coined name. We now refer to Mercks' Index, page 
76 ; under the name of Aristol, we find its true chem- 
ical name to be Thymol Iodide ; we now refer to 
Mercks price list, and find Thymol Iodide is listed at 
$4.00 a pound, and instead of paying $21.60 for the 
trade marked article, we have saved $17.60 on one 
pound. These are the points I wish to make clear. 
These are the "little things" referred to in the Fore- 
word of this book, and they are the "importance of the 
insignificant" which will save any physician hundreds 
of dollars who dispenses his own medicine. To com- 
plete the reference library for your dispensary, you 
should also secure the catalogues and price list from 
all the legitimate and reliable manufacturing chemical 
and pharmaceutical companies. 

The writer's home city — Detroit — is noted the world 
over for the superior quality of products it supplies, in 
the form of pharmaceutical specialties, fluid extracts, 



THE DISPENSARY 3y5 

tablets, pills, etc., and their literature will be of much 
value to you, as will also the catalogues from other 
firms elsewhere. I would advise you to write to Lloyd 
Bros., Cincinnati, Ohio, requesting their "Dose Book 
of Specific Medicines." This will give you much inside 
information, regarding eclectic practice and medicine. 
You should also request the "Abbott Alkaloidal Co., 
Chicago, 111., to send their valuable catalogues, and 
secure intormation regarding Homeopathic remedies 
from some reliable pharmacy ; becoming familiar with 
the practice from all schools will make you a universal 
therapeutist and a cosmopolitan physician. 

I have absolutely no use for a straight laced physi- 
cian, who follows the narrow path of any sectarian 
medical teaching or "pathy," and I feel safe to predict 
that the time is not far distant when we will have a 
united medical profession, and all men will worship a 
universal God, and when we meet the last enemy 
which physicians have devoted their lives to conquer, 
and the light of heaven streams down through the gath- 
ering mists of death, I wish you a peaceful and abund- 
ant entrance into that world of blessedness, where the 
great riddle of life will be unfolded to you in the quick 
consciousness of a soul redeemed and purified. 



396 



INDEX 



INDEX 



Page. 

ALCOHOLISM 368 

Treatment for 370 

BATHS (See Hydrotherapeu- 
tics) 49 

CANCERS (See Tumors) ..... .151 

CARBON DIOXIDE SOLIDI- 
FIED 132 

Method of Application 135 

Substitutes for 137 

Technique of Application. .. 134 
Therapeutic Use of 137 

CHIROPODY 268 

Bromidrasis 277 

Bunions 274 

Chilblain 277 

Cause of Corns 272 

Classification of Corns 270 

Diamond Corn Plaster 273 

Hanson's Corn Cure 273 

Horny Growths 276 

Hypersidrosis 277 

Ingrown Toe Nail .275 

Koler's Corn Cure.... 273 

Liebig's Corn Cure 273 

Onychis 277 

Treatment of Corns 272 

Ungual Exoxtosis 277 

COST OF OFFICE EQUIP- 
MENT 17 

COSMETIC THERAPEUTICS 
AND FEATURAL SUR- 
GERY 206 

Almond Cold Cream 219 

Birth Marks 250 

Bleaching Creams 219 

Carbolic Acid Treatment .... 216 

Cleft Palate 252 

Cosmetic Specialties 211 

Depressed Scars 244 

Diagrammatic Section of 

Skin 209 

Diseases of the Complexion. .220 

Double or Baggy Skin 248 

Ecorchement Treatment ...211 

Face Creams 218 

Face Mask 217 

Fibrolysin 246 

Goitre 248 

Hare Lip 252 

Hollow Cheeks 244 

Melvina Cream 219 

Puffiness Under Eyes 248 

Scar and Burn Marks 245 

Thiosinamine 246 

"Vanishing Cream 218 

Vesicant Treatment 214 

Vibratory Facial Massage. .. 217 

DISPENSARY 385 

DRUG HABITS 374 



Page. 
Gradual Reduction Treat- 
ment 376 

ELECTRIC LIGHT BATH 
CABINET 48 

ELECTRO-THERAPEUTICS.. 96 

Alternating Current 102 

Alternating Current Recti- 
fier 101 

Battery Solution 100 

Cataphoresis 102 

Difference in Polar Effects. .100 

Electrolysis 102 

Faradic Electricity 102 

Galvanic Electricity 99 

High Frequency Currents. . .109 

Polysine Generator 106 

Roentgen or X-Rays 108 

Sinusoidal Current 105 

Static Electricity 107 

X-Ray Generator 109 

EYE DISEASES OF 379 

Eye Therapeutics 381 

FEATURAL SURGERY 206 

F:nsen Nils Memorial 28 

GENITO -URINARY AND VE- 
NEREAL DISEASES 316 

Cystitis 333 

Hydrocele . 323 

Hypertrophy of the Pros- 
tate 330 

Impotency 327 

Spermatorrhoea 324 

Spermatorrhoea Ring 325 

Stricture 318 

Urethritis 316 

Urethral Applicator 318 

Varicocele 320 

GYNAECOLOGY 278 

Amenorrhoea 296 

Bartholinian Glands 310 

Classification of Treatment.. 279 
Corporeal Endometritis ....305 

Dysmenorrhoea 299 

Endometritis 302 

Erosions , . . . .305 

Extra Uterine Medication. .. 280 

Electrodes Uterine .-.295 

Functional Diseases of 

Women 296 

Impotency 311 

Internal Medication 280 

Intra Uterine Medications. . 290 
Intra Uterine Application. .. 293 

Infantile Uterus 297 

Laceration of Cervix 307 

Menorrhagia 301 

Metorrhagia 301 

Metritis 302 



INDEX 



397 



Sterility 314 

Urethral Caruncle 311 

Urethritis 307 

Uterine Tonics 280 

Vaginitis 307 

Vaginal Douch Therapy 281 

HAIR 258 

Electrolysis 261 

Electric Headlight 262 

Falling Hair and Baldness. .263 

Hand Electrode 263 

Hair Dyes 265 

Magnifying Glass 262 

Portable Cosmetic Battery. .261 

Superfluous Hair 258 

Superfluous Hair, Removal 

of 260 

Tonic for Dry Scalp 264 

Tonic for Oily Scalp 265 

HYDROTHERAPEUTICS 49 

Alcohol Salt and Ice Rub. . . 65 

Baths of Caracella 49 

Bath Equipment 55 

Bath Thermometer 52 

Crescent Bath Douch 71 

Cool and Cold Baths 57 

Effects of Hot and Cold 

Baths 52 

Fango Baths 52 

Medicated Baths 52 

Galvanic and Faradic Tub 

Baths 71 

Hot Air Blanket Bath 63 

Hot and Cold Douches 69 

Lava Baths \ 67 

Medicated Vapor and Tub 

Baths 65 

Mud Baths 67 

Peat Baths 67 

Pine Needle Bath 67 

Portable Bath Cabinet 60 

Russian Bath 63 

Tepid, Warm and Hot Baths.. 56 

Turkish Bath 61 

Salt Rub or Glow 73 

Sand Bath 67 

Shower Bath 70 

Shower Needle Bath 69 

Sitz or Hip Bath 68 

Sulphur Baths 66 

Stationary Bath Cabinet.... 61 
Supra Heated Air Appar- 
atus 64 

Vapor Pan and Heater 66 

HYPODERMIC MEDICATION.. 118 

HERNIA .334 

Dr. Souder's Formula 346 

Forms of Rupture 335 

Hernia Fluids 338 

Injection Treatment 337 

Langdon's Operation 342 

Langdon's Operating Case.. 344 

Paraffin Operation 345 

Technique of Operations... .340 

Treatment of Hernia 335 

Trusses 336 

LIGHT THERAPEUTICS 28 

Classification of Light Rays 30 

Color Screens 35 

Effects of Light Upon Ani- 
mal Tissue 34 



Page. 

Electric Light Bath 47 

Finsen Nils 28 

General Light Treatment... 47 

Light Areas Anterior 39 

Light Areas Posterior 40 

Light Apparatus 29 

Light as a Therapeutic 

Agent 35 

Leucodescent Light 29 

Rays of the Spectrum 33 

Regional Application of 

Light 47 

Solar Arc Lamp 31 

Technique of Light Thera- 
peutics 40 

LIQUID AIR 132 

LOCAL ANAESTHESIA 121 

Alypin 126 

Chloretone 126 

Cocaine 121 

General Anaesthesia 130 

Holocain ,..125 

Novocain 126 

Orthof orm .125 

Quinine and Urea Hydro- 
chloride 126 

Stovaine 126 

MEDICAL AND SURGICAL 
SPECIALTIES 115 

NEOPLASTIC SURGERY 144 

OFFICE EQUIPMENT 11 

Operating Table 19 

Portable Lavatory 17 

OSTEOPATHY 74 

OZONE THERAPY 111 

Ozone Generator 113 

PAINLESS. BLOODLESS, SU- 
TURELESS AND SCARLESS 
SURGERY 139 

PARAFFIN 144 

Disposition of Paraffin 149 

Melting Points 145 

Paraffin Syringe 146 

Preparations of Paraffin .... 144 

Technique of Use 147 

Use of Paraffin 144 

PHYSIOTHERAPY 20 

Motor Points of Face and 

Neck 21 

Motor Points of Arm 22, 23 

Motor Points of Thigh and 
Leg 24, 25, 26 

RECTAL DISEASES 347 

Abscess 356 

Clamp and Suture Opera- 
tion 366 

Constipation 91, 351 

Fissure 354 

Fistula 356 

Forms of Fistula 357 

Hemorrhoids ..361 

Injection Treatment 363 

Local Anaesthesia 349 

Operating Case 348 

Preparatory Treatment 347 

Pruritis Ani 367 

Rectal Electrode 352 

Treatment of Fistula 358 

SWEDISH MASSAGE 74 

THROAT, DISEASES OF 379 



398 



INDEX 



Page 

TUMORS 151 

Adenoma 159 

Angioma 158 

Cause of Cancer 167 

Carbon Dioxide Treatment. .174 

Chondroma 155 

Classification of Tumors... 152 

Colloma . 164 

Cystic Tumors 151 

Dermoid 153 

Diagnosis of Tumors.. 152 

Dr. Calot's Injection Treat- 
ment 188 

Encephaloma 162 

Eosin and Selenium Treat- 
ment 204 

Epithelioma .162 

Exudation 151 

Fell's Cancer Salve 171 

Fibroma ,.155 

Formation of Tumors 165 

Four Fluid Solvent 202 

Hydatid 154 

Injection Treatment 188 

Lipoma 154 

Lymphoma 156 

Lymphangioma 158 

Marsden's Cancer Paste. . . .171 

Malignant Tumors 160 

Melanoma 164 



Page 

Myoma 157 

Myxoma , 157 

Neuroma 158 

New Formation 153 

Papilloma 159 

Retention 150 

Osteoma 156 

Radium Treatment 188 

Sarcoma 160 

Scirrhus 161 

Solid and Semi-Solid Tu- 
mors 154 

Treatment of Tumors 169 

Treatment of Cystic Tu- 
mors .-.-.-.' 154 

Trypsin Treatment 188 

VIBROTHERAPY . ...» 79 

Abdominal Vibration 95 

Degrees of Vibration 82 

General Technique 87 

Physiological Basis 86 

Position for Treatment 86 

Shelton Vibrator 80 

Stimulation, Sedation, and 

Inhibition 82 

Vibratory Areas of Chest. . . 94 
Vibratory Areas of Back... 89 
Vibratodes 84, 85 




Third Revised and 
Enlarged Editon 
Just off the Press 



THE 

SECRETS 

OF 

SPECIALISTS 

by 
A. Dale Covey, M.D. 

A Popular Treatise 
for the Practical 
Physician. 

This book is found- 
ed upon the theory 
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"Prove all things 
and hold fast that 
which is good." 

361 PAGES 
BOUND in CLOTH 

Over 
100 Illustrations 

Price $3.00 

10,000 Copies Sold 

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This is a campanion book to "Profit- 
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The Beauty Specialists, Nostrum Specialists and others, 
gives over 500 formulas of patent medicines and their way 
of introducing them, etc. Send for illustrated table of 
contents. 

PHYSICIANS SUPPLY COMPANY 

625 Third Avenue - - - Detroit, Michigan 



15 1912 




MALTBIE'S 
PRACTICAL 
PHARMACY 



EVERY physician needs a book 
on pharmacy. Here is the book. 

It is important that physicians be- 
come familiar with the contents of 
this book. 

Prehaps some things have been 
omitted that should be included, but 
it is certain that nothing has been included that could 
be safely omitted. 

Part One treats of weights and measures, the var- 
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Part Two treats of the various galenical prepara- 
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Part Three treats of acids, alkaloids, oils, vege- 
table drugs, etc. 

Incompatibility is treated very fully. 

Contains all the preparations of the 
United States Pharmacopeia, with in= 
structions for manufacture of the ones 
that can be easily made. 

434 Pages = : = Price $3 . 00 

Printed on Good Paper and Nicely Bound in Cloth 

PHYSICIANS SUPPLY CO. 



625 Third Avenue 



DETROIT, MICHIGAN 



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